The impact of COVID-19 on diabetic patients – watch on demand

Today, many medical providers are hesitant to adopt a point-of-care testing (POCT) model for chronic disease management. In this free SelectScience® webinar, now available on demand, explore the differences between central lab testing and POCT and hear specifics about the benefits of testing for HbA1c at a point-of-care facility.

In this SelectScience webinar, now available on-demand, Join our esteemed panel of experts, including Dr. Erna Lenters Westra, European Reference Laboratory for Glycohemoglobin, Prof. Garry John, Norfolk and Norwich University Hospital, and Prof. Emma English, University of East Anglia, as they discuss what a COVID-19 diagnosis means for a patient with diabetes and what potential health impacts could follow.

Read on for highlights from the Q&A discussion and register now to watch the webinar on-demand

Have you seen or heard of any preliminary reports suggesting diabetes onset after COVID-19 diagnosis?

GJ: We are learning about this disease all the time and there is a huge controversy over whether there is a risk of developing diabetes following COVID-19 but I think the jury is probably still out on this. There have been several publications, including one from Dan Brooker that has looked at arguments for and against whether diabetes is caused by COVID-19 due to the effect on the beta cells. We know the virus is found within the beta cells of patients with diabetes who have then died, but is it a direct effect? I don't think anybody knows. There is data that showed that COVID-19 may act as a pro-inflammatory cytokine system that then induces insulin resistance and this leads to hyperglycemia and it is the hyperglycemia that has the major effect, I think, within these patients. So, I think the answer is we don't know. There is data for but whether it is secondary to other causes, we don't know.

Were there any studies that looked into the matrix effect, for example, fresh versus lyophilized blood for the same set of devices? Was this addressed in the EurA1c trial in 2020?

ELW: Yes, I have shown in my presentation the results of the EurA1c. The reason why we were investigating using threshold blood versus lyophilized material was that we distributed these samples to countries with poor distribution infrastructure to its major labs. Therefore, we choose lyophilized samples, but the problem with point of care (POC) is that most POC users don't participate in these extELWl E-quality schemes and therefore we do not know how they are performing with lyophilized material. So, as only whole blood is used in the clinical or daily routine, I think we should always go for commutable material, which is whole blood and not lyophilized material.

Maybe it's a good idea to start up a study to investigate POC instruments that can also use lyophilized material because we can then involve more users of POC in extELWl (Extravascular Lung Water Index) quality schemes, which is important. For many POC instruments, we do not know how they participate in extELWl quality schemes and that is also one of the reasons why the Australian Diabetes Educators Association are very reluctant to say that POC instruments can be used for the diagnosis of diabetes because we do not know how they are performing. Fortunately, in our EurA1c trial, we included five different POC instruments and most of them are performing as well as laboratory-based methods, so I am very happy with this.

In the meta-analysis which compared the clinical and laboratory operators, was there any discussion about the difference in training/skill level of the operators against the difference in the workflow of each setup?

EE: Yes, there was some difference in terms of the training that was provided, so there was a bit of discussion around the fact that some people probably had significantly more input in terms of their training and support than perhaps other clinical settings. But the data wasn't strong enough to be able to tease that apart and understand who'd had what support, where it would come from, and how effective that support was. What quite frequently happens with a lot of educational planning packages is there is on-the-spot training that seems to be okay and there's maybe a little test or assessment done to make sure some knowledge has been achieved.

Then what happens is you get left to your own devices, and two, three, four weeks later, you may not have that additional education support you need, then you would think, "What was I meant to do with this?" or "Who's doing that?". So, the extent of the training they had wasn't clear in a lot of the papers but it's something we're looking at for future projects so that we can assess the kind of education, support, training that's been given, but also follow that up further down the line to see what the retention of that information is as well.

ELW: I also think that a quick reference guide is very helpful for the uses of POC instruments. If you have a quick reference guide beside your instrument which helps the user that may be very helpful.

Does a patient with diabetes have the same level of severity risk for different COVID variants?

GJ: Again, I think it's almost an impossible question to answer because we are still learning this. There doesn't appear to be any worsening of clinical effects with different variants in the population as a whole, so we would probably think maybe not in diabetes either. The major increased risk, of course, is with the increased infectivity that we're seeing with these variants, so we are seeing more and more people were catching the disease. But the very fact of the increased number of people had, of course, increased the number of people with diabetes as well, there's a possibility that there will be an increase in the severity in some people purely based on the increased number of people that are catching the disease. In terms of whether the different variants have a different clinical effect within the diabetic population, I think that is currently unknown.

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