COVID-19 and diabetes: perspectives from Europe

An estimated 59 million people are living with diabetes in the International Diabetes Federation (IDF) Europe (EUR) Region, which covers 44 countries and territories. Over 1.5 millions cases of COVID-19 have been recorded across Europe and national authorities throughout the region have put in place various restrictive measures to manage and prevent the spread of the virus.

People with diabetes and health professionals in the region have been impacted in many ways. We asked IDF EUR Region Chair, Dr. Niti Pall to share her insights on what the impact has been and how, in the longer term, COVID-19 will shape the lives of people with diabetes and health professionals in the region.

What has been the impact of COVID-19 on people living with diabetes in your region?

People with diabetes in the European region are generally coping well. We have found that access to services has generally been maintained for routine care. This has been mostly through digital appointments, and doctors and nurses making themselves available to their patients by telephone. We have also generally found that access to medicines such as insulin has been good, apart from some countries in Eastern and Central Europe where there were issues at the start of the pandemic. People with complications are finding it harder to access services, especially if they need a face-to-face consultation with a health professional, for example, to check their feet or their eyes.

What has been the impact of COVID-19 on diabetes health professionals in your region?

Health professionals working in diabetes have generally been protected in terms of accessing their patients. It is when you need to see somebody face-to-face that people have found it initially difficult to get good advice on what protective equipment to wear and where it is safe to see patients. If a health professional has needed to do a procedure on a person with diabetes, the information has not been great. There has been a huge supply chain issue regarding Personal Protective Equipment (PPE) for health professionals across the region. Every European country has suffered the same as everywhere else in the world.

Testing has also been an issue, like in other parts of the world.  Throughout the region, there have been problems with access to tests, not just for the public, but also for health professionals who may be at risk or already have symptoms of the virus. The situation has been better in some countries than in others. Germany is a good example of where testing has happened pretty rapidly. Other countries in Western Europe have started testing as well, but test kits have not been so well available in Central and Eastern Europe.

How have national authorities responded to the situation?

Some national authorities have responded quicker than others. Advice on COVID-19 started coming early, including information on sick-day rules, what you should do if you have diabetes and COVID-19, who is at risk and the importance of protecting people with chronic health issues. Some countries responded quicker to lockdown, some countries responded quicker to identify those at risk and some countries acted quicker to do testing. It has been a mixed picture across Europe and that is reflected in the number of people that have been infected and the number that have lost their lives.

How has the pharmaceutical industry and civil society responded?

The pharmaceutical industry has responded well to the challenges that COVID-19 has posed to people with diabetes. We published a report on the situation concerning diabetes medicines and supplies in the region, which industry very heavily contributed to. We found that although there were logistics problems caused by the lockdown measures, the supply chain has been generally maintained as a result of industry and governments acting cooperatively. They have also responded well to civil society and diabetes organisations, providing moral support, information and continuing to support our efforts to raise awareness of diabetes.

Diabetes associations and civil society have stepped up across Europe. We have had several conversations with diabetes associations, both professional and representing people with diabetes, across the region. They have been disseminating good information for people with diabetes, particularly across social media platforms. The digital age has finally arrived. It took a crisis to get us there but we’ve arrived in the digital age and engagement through social media platforms has been particularly good during this time.

What do you think will be the longer-term impact of the COVID-19 pandemic on people with diabetes and health professionals?

I think the long-term effect of COVID-19 on people with diabetes will be quite marked, particularly for people who have not been able to access care, such as those living with complications. As a result of people being afraid of going to the hospital to access healthcare, we are going to see people presenting late with complications affecting their eyes, feet, heart and kidneys. We are already seeing this in medical admission units across Europe. There is, however, a silver lining to these clouds, and that is that many more people will be able to access their care online or digitally.

For health professionals post-COVID, we’re going to see a different way of working and that different way of working is going to require a different kind of skill-set – digital multidisciplinary teamwork – because that’s what people are going to expect now. How we interact with patients digitally, particularly involving the multidisciplinary team is going to be important. COVID-19 has also shown, particularly in some of the Western European countries, how quickly roles have been repurposed to be used for efforts against that virus. If that can happen for COVID-19, I think roles can be repurposed and rescaled for diabetes care as well. We have been waiting for that for a long time, and I believe that for health professionals, this is going to involve a different way of working, as well as new roles and developments that can be fast-tracked to help deliver care for the future.

I feel that the role of the voice of the person with diabetes is going to get bigger after COVID-19 and rightly so. We need to facilitate that and make it happen. We do not want to lose the voice of the person with diabetes, particularly regarding the way that they want their care to be structured. Too often, we have not listened to the way that they want their care structured around them. This is a golden opportunity to make that happen properly for people with diabetes. People with diabetes are collaborating much more with each other on social media platforms, and that is only to be encouraged and paid attention to. Healthcare professionals should engage with that more.