COVID-19 Lockdown Related Telemedicine for Type 2 Diabetes

Impact of Telemedicine on Young and Middle-aged Obese Patients With Type 2 Diabetes Mellitus During COVID-19 Pandemic

At present, in order to cope with the global pandemic of the COVID-19 virus, governments have introduced corresponding measures, COVID-19 lockdown is one of the most important measures. However, lockdown makes the management of chronic diseases (such as type 2 diabetes) more difficult, and telemedicine may be one of the solutions. We hope to explore the effect of telemedicine on blood glucose control and other prognostic indicators of young and middle-aged obese patients with type 2 diabetes who will experience isolation control.

We recruit patients with type 2 diabetes who need to be isolated due to the COVID-19 epidemic, Our study will include young and middle-aged obese patients. The lockdown period is 21 days. The patients will be randomly divided into two groups with a total follow-up time of 6 months. One group is the telemedicine intervention group, and the other group is the routine follow-up control group. The intervention group used the hospital telemedicine management system to upload blood glucose values (fasting and 2h after three meals), food intake of three meals, and exercise volume (Data collection frequency: first three months, 4 times/week; 4-6 Month, 2 times/week).Doctors will collect data from hospital telemedicine management system to guide patients on diets, exercise, and medication adjustments. The control group will be followed up by telephone/outpatient clinic every 1 week. (only telephone follow-up will be conducted during the lockdown period) Then doctors will collect their blood glucose values.(fasting and 2h after three meals) Based on the data collected, The doctors will provide lifestyle guidance to the patients on the telephone or face to face. The clinical data of the two groups of patients will be collected at baseline, 22 days, 3 months, and 6 months respectively. (HbA1c, fasting blood glucose(FBG), blood glucose 2 hours after breakfast, blood pressure, Body Mass Index(BMI), waist-to-hip ratio, total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), Blood Urea Nitrogen(BUN), serum creatinine(Scr), e-GFR, Self-rating Depression Scale, frequency of hypoglycemia，and Cost effectiveness) The clinical data will be statistically analyzed.

Patients upload data of blood glucose, diet and exercise. Then doctors guide patients' diet, exercise and medication adjustment through the telemedicine system.

Outpatient/telephone follow-up：continued care, as usual, from their primary care provider through out duration of action 6 months intervention period

Change in Blood glucose 2 hours after breakfast among control and telemedicine groups from baseline to 6 months

Comparison of waist-to-hip ratio changes among control and telemedicine groups from baseline to 6 months

Variation between baseline to 6 months of Biological parameter among control and telemedicine groups: TC

Variation between baseline to 6 months of Biological parameter among control and telemedicine groups: TG

Variation between baseline to 6 months of Biological parameter among control and telemedicine groups: HDL-C

Variation between baseline to 6 months of Biological parameter among control and telemedicine groups: BUN

Variation between baseline to 6 months of Biological parameter among control and telemedicine groups: Scr

Variation between baseline to 6 months of Biological parameter among control and telemedicine groups: e-GFR

Self-rating Depression Scale includes 20 items in four dimensions of psychological disorders, namely, psychotic emotional symptoms, somatic disorders, psychomotor disorders, and depression. The maximum value of SDS is 50 points. A lower total score means a better situation in terms of depression and vice versa

The objectives are to compare the results of the study in terms of cost and cost-effectiveness of these two strategies

Inclusion Criteria: Physician diagnosis of Type 2 diabetes for more than 6 months 7.0%<HbA1c<10.0% Quarantine for 21 days due to COVID-19 outbreak related reasons age: 18 ~ 55 yrs BMI≥24 Be able use smart phones and the Internet Exclusion Criteria: Insulin pump users For female subjects: pregnancy or lactation, or subject may become pregnant during the study Patient who underwent obesity surgery to the exclusion of a gastric band, loosened or removed for more than a year Patients diagnosed with COVID-19 infection Have severe complications (chronic heart disease, cerebrovascular disease, diagnosed HIV/AIDS, cancer, emphysema, chronic liver or kidney disease) that would affect the subjects' ability to follow the tailored advice

Yin W, Liu Y, Hu H, Sun J, Liu Y, Wang Z. Telemedicine management of type 2 diabetes mellitus in obese and overweight young and middle-aged patients during COVID-19 outbreak: A single-center, prospective, randomized control study. PLoS One. 2022 Sep 29;17(9):e0275251. doi: 10.1371/journal.pone.0275251. eCollection 2022.