Timely News and Notes for Primary Care Providers From the American Diabetes Association

Euglycemic Diabetic Ketoacidosis in a Patient Prescribed Empagliflozin and a Ketogenic Diet: A Case of Misdiagnosed Type 1 Diabetes

COVID-19 and Diabetes Care: A “New Normal” EmergesAs the dual pandemics of coronavirus disease 2019 (COVID-19) and diabetes grind on, we look at how care for individuals with diabetes has changed since COVID-19 emerged a year ago.Experience in an Early HotspotOne of the earliest outbreaks of COVID-19 occurred in the municipality of Vo’ in the Northern Italian province of Padua. Control measures (lockdown and case isolation) and mass testing effectively stopped that outbreak relatively early on, according to an investigation published in Nature (doi.org/gg3w87). Although the reported rate of asymptomatic cases (42.5%) is enlightening, the researchers found no links, at the time, with common comorbidities such as diabetes and cardiovascular disease (CVD).Nevertheless, diabetes has emerged as a global risk factor for the worst outcomes of COVID-19, and we now learn that the impact of the virus on diabetes care levels in Padua Hospital (where most cases from Vo’ were admitted) was significant during the lockdown period of 15 March to 14 April 2020. In a letter published in Diabetes Care (doi.org/fhwr), Bonora et al. describe how the number of onsite and online visits for diabetes care was 47.7% lower during the lockdown period than during equivalent periods the previous 2 years.The reductions in visits were reportedly higher for type 2 diabetes than for type 1 diabetes, with most visits that did occur carried out via email, telephone, and online methods. The authors note that patients with type 2 diabetes who were seen during lockdown were younger and had less severe disease compared to previous years, implying that older patients with a heavier disease burden struggled to connect to receive appropriate care. There was also reportedly a halt in prescriptions for glucagon-like peptide 1 receptor agonists, as well as reduced use of antiplatelet and lipid-lowering therapies, suggesting a worsening of CVD risk. The authors noted, however, that there was …

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