COVID-19: it's changed us.

January 2020. Robert (not the patient's true name) entered my clinic room and shook my hand without hesitation. Aged in his late 60s, he had lived with type 1 diabetes for more than 50 years. I reminded myself how much I cherished seeing the ‘survivors’, so rich in lived experience and archived lessons. Robert's story did not disappoint.

The memory reel began. His diagnosis as a boy, and the doctor that premised poor likelihood of survival to adulthood. The 100 000 insulin injections needled into his skin over his lifetime, tallied during a reflective moment. To survive he initially relied on animal insulin extract, delivered by blunt syringe. He marvelled at the idea of modern automated insulin delivery methods but still preferred pens to an insulin pump. But glucose monitoring options sparked his curiosity the most, since after all, in the beginning he had none. He struggled with glucose lability and grieved the loss of symptomatology of a low glucose event, likely from decades of recurrent hypoglycaemia and impaired metabolic defence mechanisms. On demand measurement of interstitial fluid glucose levels without finger lancing? Magic.

Hypoglycaemia caused him (and me) greatest anxiety. This was unsurprising as his brother, also affected by type 1 diabetes, died following a severe episode. Consequently, Robert checked his capillary glucose levels by finger‐prick several times an hour, and throughout the night. He never wanted to fall unconscious again like he did at work a few weeks ago. Together we reflected on the evolution of diabetes management and gave thanks for scientific advancement. I suggested trialling continuous glucose monitoring with alarm capacity to capture and manage hypoglycaemia earlier.

By the end of our consultation, I understood where diabetes fitted within his narrative. With a hint of pride, he planned to show me his Kellion Victory medal at his next appointment in April. Decorated for surviving for 50 years against all odds, this generation of people with type 1 diabetes weathered the journey by resilience, self‐management and expert capacity for adaptation.

February 2020. It was business as usual for us. Phones buzzed, laboratory machines whirred and laughter spilt from the lunch room. We spoke excitedly about travels to an upcoming international meeting and deliberated over where we will fit our growing referrals for diabetes care. We continued to conjure ideas for future research initiatives and fielded calls from volunteers for our active type 1 diabetes projects – their way of ‘giving back’ to science, they said. Our mission to improve the health of people living with diabetes was a slow but important task. We knew that well.

March 2020. A trickle of emails. Local cases. Restrictions on returning travellers. Then a gush. A deluge of updates from health services, universities and governments. It was hard to keep up. The canary in the gold mine for us was the cancellation of international conferences due to anticipated COVID‐19 outbreaks, and the requirement for quarantine on return. Overnight, our department, our hospital, our research institute and our university retreated, ready for lockdown. Monday morning battle briefings were instituted. Anxiety was high but messaging was key – a fine balance between over‐reaction and modelled reality. The restrictions on gatherings progressed from 500 to 2. Meetings outlawed, lunch room cordoned, elbow bumps only please. Videoconferences and online meetings dictated our days, but days felt like weeks. We would wait for the daily announcement of new restrictions until finally, stay at home orders were imposed. Tools downed in the laboratory, the typhoon was coming, and we needed to take shelter. Sydney held its breath.

The overseas accounts were harrowing. We pained for our international colleagues and worried for our own. Would we be asked to join the ranks of our hospital front lines? Apprehension for our patients grew. How would we continue chronic care amid the calamity? We read the data from Wuhan. People with diabetes were among those with the worst outcomes. Our patients understood this too.

They rang. ‘The chemist is out of ketone strips. My insulin supply is running low and I can't do without it.’ We had colleagues with type 1 diabetes, emergency physicians, surgeons. ‘Am I safe at work?’ they asked.

Overnight, our clinics upheaved. All appointments converted to telehealth, a move that we had advocated for years without success. We talked through our patients' unease, revised sick day management and posted their prescriptions to their homes. We discussed that there was a lack of data on COVID‐19 outcomes in type 1 diabetes, but that metabolic vulnerability was ever‐present. We would adhere to common sense principles: optimise glucose levels and maintain social distancing.

April 2020. My second appointment with Robert was via videocall. He was thriving with his new continuous glucose monitor and felt more confident. His HbA1c had reduced by a whole percent with less hypoglycaemia, after trying the simple measures we discussed in partnership. In fact, he recognised that this consultation format held great potential, especially now that his glucose reports could be reviewed remotely, and that above all, what our appointment needed was good quality conversation.

The year so far has been a confusing whirlwind of change. Ferocity at first, followed by stillness. In Australia, we have been blessed with the gift of time and experience of others not so lucky. Like many, we did not expect the pandemic to change so many aspects of our professional lives and did not expect the turmoil to exert the benefits it has. Our delivery of chronic disease care has evolved. Our relationships with our colleagues are stronger. We have forged new bonds that would have taken decades to develop or may have never developed at all. Yet we are saddened by the delays in our research and lost opportunities to realise our long‐term missions.

For our patients, COVID‐19 has also brought a new wave of apprehension. We are reminded that for those living with chronic disease, sacrifice and change is nothing new, and often permanent. Akin to a life‐altering diagnosis, the events of the first months of 2020 hit us hard. As we realise the chronicity of this pandemic and the uncertainty this creates, we should recognise there are the opportunities to learn from our patients. May we recalibrate and adapt, just as they always have.