This paper aimed to provide evidence on the impact of COVID-19 on diabetic control, including HBA1C, LDL, BP, and BMI, in diabetic patients attending Alkhuwair Health Centre, comparing 2019 (pre-COVID) and 2020 (post-COVID).
The results showed statistically significant HbA1c, systolic BP, and BMI changes between 2019 and 2020. The mean HbA1c in 2019 (6.9%) was significantly lower than in 2020 (7.2%). After resuming the clinic, it was noticed that some patients had higher glycated haemoglobin (HbA1c) levels than last year. SARS-CoV2 virus could interfere with the glucose metabolism pathways by triggering the reprogramming of the glucose metabolism through AMP activating protein kinase with no effect on the pancreas (Rochowski et al.,) (18). HBA1c results are consistent with a study that found that HbA1c values significantly increased from 7.45–7.53% during the pandemic (Tanji et al., 2021(19). However, a Spanish study on the COVID-19 lockdown’s impact on glycaemic control in patients with type 1 DM found that despite the lockdown, there were improvements in glycaemic control in patients with type 1 DM due to self-management (Fernández et al., 2020;) (12). Both sex and age groups did not differ significantly in our study regarding HbA1c in 2020. These results were inconsistent with the conclusion of Tanji et al., who noticed that the deterioration in HbA1c values was more apparent in women, patients aged ≥ 65 years, patients with BMI > 25, and patients not using insulin (Tanji et al., 2021)((19).
The mean BMI in 2019 (30.49) was significantly lower than in 2020 (30.80). This finding can be explained by the lockdown, reducing physical activity, and changing lifestyle habits which lead to raising awareness about the importance of nutritional status for a healthy lifestyle (Al Agha et al., 2021; Urzeala et al) (20, 21). Considering the extreme weight categories associated with severe COVID-19 complication risk, we noticed that 13.11% of the total sample fell into these vulnerable categories. Being overweight or obese is an independent risk factor in severe COVID-19 patients because enhanced adiposity diminishes pulmonary function (Urzeala et al., 2022) (21). Healthy lifestyles and choices should be promoted in primary care centres with the help of multidisciplinary teams. Obesity and overweight rates are on the rise, especially in the eastern Mediterranean region, which will cause a further burden on our health systems (Nejadghaderi et al. 2023(22)
Another factor that could be implicated here is stress, anxiety, and isolation, especially for older people, which was reported during the COVID-19 pandemic (Palmer et al., 2020; Urzeala et (21, 23). Stress is an important factor implicated in the dysfunctionality of the sympathetic nervous system and the hypothalamus that leads to obesity. The other consequence of stress is the tendency to develop eating disorders and lower physical activity. All these factors might explain the increase in BMI noticed in the study cohort (Correia et al., 2021) ((24). Positive relationships were found between dealing with stress related to COVID-19 in patients with NCD and active coping strategies, for example, self-distraction, denial, substance use, behavioral disengagement, venting, planning, religion, and self-blame (Umucu et al.2020)(25)
In addition to HBA1c and weight, clinic patients showed high systolic BP and LDL. The results are in line with Akpek 2020, which suggests that infection with SARS-CoV-2 increases systolic and diastolic BP and could lead to hypertension(Akpek 202) (26). In our study, only systolic BP was significantly higher, but diastolic BP was not. However, the results contradict Feitosa et al., who showed no considerable adverse impact of COVID-19 on office and home BP (Feitosa et al.).(27)
Many studies considered an association between antihypertensive medication classes and patient outcomes, but almost all are retrospective investigations or meta-analyses. Therefore, well-conducted research with a considerable number of hypertensive patients is necessary to resolve current controversies about the relationship between hypertension and COVID-19 (Tadic et al., 2021(28)
Telemedicine consultation existed at a comparable percentage to physical consultation, which is attributed to the fact that in Oman, the health system, like other countries, adopted many changes in NCD routine management (Bouabida et al., 2022; Habbash et al., 2023; Ullas et al., (29–31). The Directorate of General Health Services in Muscat implemented a telemedicine clinic twice weekly for patient follow-up and consultation in the primary care setting. So, the results align with Chudasama et al., in 2020, which showed that 45% of the participants’ healthcare providers performed telephone (32). Furthermore, a WHO survey of 155 countries found that 58% now use telemedicine to replace in-person consultation (WHO), (3).
Limitations:
Residual confounding can be a challenge in observational studies. To address this, we should include as many confounders as possible in the regression analysis and seek the opinions of clinical experts. Additionally, sensitivity analysis was employed to evaluate any hidden residual confounding, such as mental instability. Negative outcome control could be applied to explore any hidden confounding due to measurement errors for lifestyle factors. Missing data is a major potential limitation. We tried to locate and reference relevant sources of patient information to retrieve any missing data from electronic health records. Furthermore, we performed a sensitivity analysis to manage the missing data Selection bias was another concern. Some of the Omani population receive medical care in private institutions that are not registered in the national registries.