Because older adults with diabetes are an at-risk population for encountering numerous challenges during the COVID-19 pandemic, it is important to support them and their needs during this time. In a guidance statement published in JAMA Internal Medicine, 2 physicians published their thoughts on how to optimize care for diabetes patients aged ≥70 years during the COVID-19 pandemic.
The pandemic may affect older patients’ ability to manage their diabetes in both direct and indirect ways, the authors noted. Difficulties in receiving care through telemedicine, changes to their daily routine, and financial constraints can impact a patient’s or their caregiver’s ability to properly manage their diabetes.
The authors of the article, Sarah L. Sy, MD, and Medha N. Munshi, MD, of the Joslin Diabetes Center in Boston, advised that clinicians should simplify their patients’ diabetes treatment plans to address a variety of pandemic-related complications. Some older patients may struggle with uploading data from their glucometers, continuous glucose monitors, and/or insulin pumps to computer applications, while some do not have access to a computer at all.
This does not indicate, however, that clinicians should dismiss a missed telemedicine visit from a geriatric patient under the assumption that they were unable to access the necessary tools, according to the authors. A missed telemedicine visit could be indicative of crises like a fall or episode of hypoglycemia, and clinicians should contact the patient via phone call or reach out to the patient’s family.
The authors proposed that especially for high-risk patients, such as those with type 1 diabetes or with recurrent hypoglycemia, prioritizing goals and providing repeated education under a streamlined treatment plan may help patients be more successful in managing their diabetes. Simplified treatment plans, consolidated medicines, and ensuring that patients have a sufficient supply of prescription refills and additional tools to manage their diabetes may also help them reduce face-to-face interactions with caregivers, preventing increased potential exposure to COVID-19.
Due to frequent COVID-19 outbreaks in nursing homes, some families have chosen to remove their relative from the facility and care for them in their residence. The authors suggested clinicians establish communication with the patient’s family to ensure that they are equipped to properly care for the patient.
The pandemic has the potential to affect patients’ access to diabetes-friendly food; patients may struggle to access grocery stores or afford certain foods due to financial constraints associated with the pandemic. The authors proposed that instead of striving for optimal nutrition, clinicians should advise their patients to eat regular meals, spread carbohydrate intake throughout the day to avoid large blood glucose spikes, and perform light exercise at home, including indoor walking for 10 minutes 3 times per day or strength training with resistance bands or household items.
The authors noted that while the pandemic poses a threat to the physical health of older adults with diabetes, it may affect their mental health in a similar fashion. Clinicians should encourage patients to communicate with their friends and family through virtual channels to maintain social connections whenever possible. Screening patients and their caregivers for depression and referring them to a mental health colleague, if needed, should be a significant marker of overall care.
“Many of the recommendations presented in this article are practical and will continue to be relevant after COVID-19,” stated the study authors. “When this is all over, patients will remember how we made them feel, and how we kept them safe and healthy at home.”
Sy SL, Munshi MN. Caring for older adults with diabetes during the COVID-19 pandemic [published online July 13, 2020]. JAMA Intern Med. doi:10.1001/jamainternmed.2020.2492