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World Diabetes Day gives us an opportunity to reflect on, and recognise, all the great research being done across the Nuffield Department of Primary Care Health Sciences and Centre for Evidence-Based Medicine (CEBM), to review the evidence on COVID-19 and diabetes.

Image of woman with a digital monitoring device

This year's theme of World Diabetes Day focuses on diabetes education and calls on policymakers to increase access to diabetes education to help improve the lives of the more than half a billion people living with diabetes worldwide, something that we here at Oxford, are committed to supporting and improving.

In response to the COVID-19 pandemic, a team of Oxford experts at the CEBM set-up the COVID-19 evidence service; providing rapid evidence reviews and data analysis relating to the pandemic, of which there are now over 300 articles.

In Spring of 2020, as part of the COVID-19 Evidence Service, Associate Professor and Director of the Evidence-Based Health Care DPhil programmeDr. Jamie Hartmann-Boyce, led a research project alongside members of CEBM, clinicians, and undergraduate and postgraduate students, designed to ascertain the risks and management of diabetes and COVID-19, whilst taking into account learnings from other national disasters. This project holds both personal and professional value as Dr. Hartmann-Boyce lives with type 1 diabetes. 

Evidence, published in Diabetes Care, suggested that people with diabetes (PWD) appear to be at increased risk of more severe COVID-19 infection, whilst evidence quantifying that risk was highly uncertain. As well as posing direct immediate risks to PWD, COVID-19 also risks contributing to worse diabetes outcomes due to disruptions caused by the pandemic, including stress and changes to routine care, diet, and physical activity. Findings showed a high potential for COVID-19 to exacerbate existing health disparities, and Dr. Hartmann Boyce encourages research and practice guidelines to take this into account.

As a follow up, the team were commissioned by the World Health Organisation (WHO) to systematically review the latest research evidence on the impact of coronavirus disease 2019 (COVID-19) on people with diabetes (PWD), particularly in relation to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated deaths.

Data from 112 systematic reviews, also published in Diabetes Care, revealed that diabetes increases risk of severe COVID-19, but showed no evidence to prove or disprove whether diabetes makes PWD prone to infection with SARS-CoV-2. Findings also showed that both diabetes and worse COVID-19 outcomes are associated with socioeconomic disadvantage, which risks further exacerbation of existing health disparities. 

WHAT'S NEXT?

The team are now undertaking two further pieces of work for WHO, to further address the risks and impact of the pandemic on people living with diabetes and build on research being done with collaborators at the University of Leicester, to identify evidence on the impact of COVID-19 and lockdown diabetes outcomes. This builds on earlier work supported in part by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Oxford, NIHR Applied Research Collaboration East Midlands and Thames Valley at Oxford Health NHS Foundation Trust. That work, published in Diabetes, Obesity and Metabolism, found that the COVID-19 pandemic was associated with small improvements across multiple outcomes of glycaemic control, but insufficient evidence to suggest this led to changes in blood glucose levels. Most evidence came from people with access to diabetes technologies in high-income countries; more research is needed in less advantaged populations.

As well as reviewing academic evidence, Dr. Hartmann-Boyce and GP and DPhil student Dr. Elizabeth Morris were keen to share findings with the diabetes community and hear from people living with diabetes about their experiences, which culminated in the 'Diabetes during COVID-19' project. This project aimed to bridge the gap between objective evidence synthesis research into the impact of the pandemic on PWD, and the reality of lived experience. PWD were invited to submit art or written work, that reflects on their unique experience during the COVID-19 pandemic. 

Patient and public involvement (PPI) representative for this project, Gaynor Allen, wrote a news piece for the NIHR about her involvement in the project. 

Affie Otunla is a DPhil alumnus who was also involved in this research. When asked about his experience, he said: 'Working with Jamie and the rest of the team on our review on the impact of COVID19 on people with diabetes was an incredibly rewarding experience. Not only did it teach me a lot about the process of planning and carrying out a systematic review, an invaluable skill, but it was also satisfying knowing that our work would meaningfully contribute to how diabetes care during the pandemic is viewed by clinicians and patients'.

Dr. Hartmann-Boyce has also written two articles for The Conversation about the link between diabetes and COVID-19:

Coronavirus and diabetes: the different risks for people with type 1 and type 2 (2020) - shortlisted for an Association of British Science Writers Award (the Katherine Giles award) in 2021:

People who’ve had COVID appear more likely to develop diabetes – here’s why that might be (2022).

 

The team remains committed to the development and dissemination of evidence around diabetes to inform and educate policymakers, practitioners and the public. They look forward to producing more research in this area and would like to thank everyone involved.

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