Samereh Abdoli1, Monica S V M Silveira2, Mehri Doosti-Irani3, Paulo Fanti2, Katherine Miller-Bains4, Elizabeth João Pavin5, Edimariz Buin Cardoso6, Leila Rafiee Vardanjani3, Kobra Noorian3, Danielle Hessler7. 1. College of Nursing, University of Tennessee, 1200 Volunteer Blvd Rm 155, Knoxville, TN, 37996, USA. sabdoli@utk.edu. 2. Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil. 3. School of Nursing and Midwifery, Shahrekourd University of Medical Sciences, Shahrekord, Iran. 4. Assessment and Evaluation, Oak Ridge Associated Universities, Oak Ridge, TN, 37831, USA. 5. Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil. 6. Clinical Psychologist, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil. 7. Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, San Francisco, CA, 94117, USA.
Abstract
BACKGROUND: The COVID-19 pandemic is a global public health emergency, which presents wide-ranging negative impacts on individuals with diabetes. To examine psychosocial well-being and diabetes outcomes in individuals with type 1 diabetes during the COVID-19 pandemic, and investigate how these factors vary in different countries. METHODS: Between April and June 2020 we employed a cross national comparative research study in the United States (US), Brazil, and Iran to collect data from 1788 adults with type 1 diabetes using web-based survey. Study participants answered questions relevant to diabetes distress, diabetes burnout, depressive symptoms, COVID-19 related changes, and socio-demographic characteristics. They also reported their last Hemoglobin A1c (HbA1c) and daily Time-in-Range (TiR) blood glucose. We analyzed data using comparative tests (Chi-square, Kruskal-Wallis and McNemar test), logistic and linear regression adjusted for fixed effects. RESULTS: There were significant changes prior and during the pandemic regarding access to diabetes care, diabetes supplies and medications, healthy food and safe places to exercise in all countries (p < 0.05). Participants in Iran experienced higher levels of diabetes distress (57.1%), diabetes burnout (50%), and depressive symptoms (60.9%), followed by Brazil and US (p < 0.0001). US participants reported better glycemic control (HbA1c = 6.97%, T1R = 69.64%) compared to Brazil (HbA1c = 7.94%, T1R = 51.95%) and Iran (HbA1c = 7.47%, T1R = 51.53%) (p < 0.0001). There were also significant relationships between psychosocial well-being, diabetes outcomes, socio-demographic data, and COVID-19 related challenges in overall sample (p < 0.05). CONCLUSIONS: Regardless of differences among US, Brazil, and Iran, our findings revealed that different countries may experience similar challenges related to the COVID-19 pandemic which can impact negatively diabetes outcomes and psychosocial well-being in individuals with type 1 diabetes. Countries need to consider modifiable variables associated with poor diabetes outcomes and sub optimal psychosocial well-being and target vulnerable population using significant socio-demographic variables.
BACKGROUND: The COVID-19 pandemic is a global public health emergency, which presents wide-ranging negative impacts on individuals with diabetes. To examine psychosocial well-being and diabetes outcomes in individuals with type 1 diabetes during the COVID-19 pandemic, and investigate how these factors vary in different countries. METHODS: Between April and June 2020 we employed a cross national comparative research study in the United States (US), Brazil, and Iran to collect data from 1788 adults with type 1 diabetes using web-based survey. Study participants answered questions relevant to diabetes distress, diabetes burnout, depressive symptoms, COVID-19 related changes, and socio-demographic characteristics. They also reported their last Hemoglobin A1c (HbA1c) and daily Time-in-Range (TiR) blood glucose. We analyzed data using comparative tests (Chi-square, Kruskal-Wallis and McNemar test), logistic and linear regression adjusted for fixed effects. RESULTS: There were significant changes prior and during the pandemic regarding access to diabetes care, diabetes supplies and medications, healthy food and safe places to exercise in all countries (p < 0.05). Participants in Iran experienced higher levels of diabetes distress (57.1%), diabetes burnout (50%), and depressive symptoms (60.9%), followed by Brazil and US (p < 0.0001). US participants reported better glycemic control (HbA1c = 6.97%, T1R = 69.64%) compared to Brazil (HbA1c = 7.94%, T1R = 51.95%) and Iran (HbA1c = 7.47%, T1R = 51.53%) (p < 0.0001). There were also significant relationships between psychosocial well-being, diabetes outcomes, socio-demographic data, and COVID-19 related challenges in overall sample (p < 0.05). CONCLUSIONS: Regardless of differences among US, Brazil, and Iran, our findings revealed that different countries may experience similar challenges related to the COVID-19 pandemic which can impact negatively diabetes outcomes and psychosocial well-being in individuals with type 1 diabetes. Countries need to consider modifiable variables associated with poor diabetes outcomes and sub optimal psychosocial well-being and target vulnerable population using significant socio-demographic variables.
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