UK expert panel risk-stratifies patients with diabetes amidst COVID-19 pandemic

  • Choudhary P & al.
  • Diabet Med
  • 23.11.2020

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • During the ongoing COVID-19 pandemic, the Association of British Clinical Diabetologists, Diabetes UK, and the Primary Care Diabetes Network advise stratifying care of adult patients with diabetes based on risk.
  • Recommendations should be undertaken holistically, including comorbidities, ethnicity, and socioeconomic deprivation.

Proposed risk stratification

  • REVIEW URGENTLY (within 3 months, virtually or in-person):
    • HbA1c >10% (86 mmol/mol);
    • BP >160/100 mmHg;
    • Complete hypoglycemia unawareness (Gold score 7) or reported severe hypoglycemia in past year;
    • Hospital admission for diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, or unstable cardiac/cerebrovascular disease in past year;
    • Recently discharged with treatment changes;
    • Estimated glomerular filtration rate (eGFR) 2 or renal function decline >15 mL/minute/year;
    • Active diabetic foot disease; and
    • Other factors: severe mental illness, learning difficulties, frailty, women planning pregnancy.
  • REVIEW as PRIORITY (within 6 months):
    • HbA1c: 8.5%-10% (70-86 mmol/mol);
    • BP: 140-160/90 mmHg or total cholesterol >5 mmol/L;
    • Impaired hypoglycemia awareness (Gold score 4-6), or >5 episodes/week or >20% time
    • HbA1c
    • eGFR 45-30 mL/minute/1.73 m2, albumin-to-creatinine ratio >30;
    • Age
    • No diabetes review for >18 months.
  • In the ROUTINE category:
    • Others may be postponed until mid-2021.
    • Give patient educational resources and instructions about what to do if parameters change.