Association between SGLT2 inhibitor treatment and diabetic ketoacidosis and mortality in people with type 2 diabetes admitted to hospital with COVID-19

   Objective  To determine the association between prescription of SGLT2 inhibitors and diabetic ketoacidosis (DKA) incidence or mortality in people with type 2 diabetes hospitalized with COVID-19.  Research Design and Methods  This was a retrospective cohort study based on secondary analysis of data from a large nationwide audit from a network of 40 centres in United Kingdom with data collection up to December 2020 that was originally designed to describe risk factors associated with adverse outcomes among people with diabetes who were admitted to hospital with COVID-19.. The primary outcome for this analysis was DKA on or during hospital admission. The secondary outcome was mortality. Crude, age-sex adjusted and multivariable logistic regression models, were used to generate odds ratios and 95% confidence intervals for people prescribed SGLT2 inhibitor compared to those not prescribed SGLT2 inhibitor.   Results  The original national audit included 3067 people with type 2 diabetes who were admitted to hospital with COVID-19, of whom 230 (7.5%) were prescribed SGLT2 inhibitors prior to hospital admission. Mean (SD) age of the overall cohort was 72 years, 62.3% were men and 34.9% were prescribed insulin. Overall, 2.8% of the total population had DKA and 35.6% people died. The adjusted odds of DKA were not significantly different between those prescribed SGLT2 inhibitors and those not (OR 0.56, 0.16-1.97). The adjusted odds of mortality associated with SGLT2 inhibitors were similar in the total study population (OR 1.13, 0.78-1.63 ), in the sub-group prescribed insulin (OR 1.02, 0.59-1.77), and in the sub-group that developed DKA (OR 0.21, 0.01-8.76).  Conclusions We demonstrate a low risk of DKA and high mortality rate in people with type 2 diabetes admitted to hospital with COVID-19 and limited power but no evidence of increased risk of DKA or in-hospital mortality associated with prescription of SGLT2 inhibitors. </p

Future of information technology and telecommunication in type 1 diabetes clinical care: results of an online survey

Objective: To assess the attitude of people living with type 1 diabetes toward the use of information and communication technology (ICT) to facilitate access to diabetes healthcare professionals (HCPs). Research design and methods: We conducted a cross-sectional online survey in two European tertiary diabetes care centers in London, UK, and Vienna, Austria, and from online diabetes platforms. Participants were asked about general options of online diabetes care and were presented with three scenarios (teleconference, online chat and telemonitoring of continuous glucose monitoring traces). Results: In total, 294 people (59% female; 78 British, 164 Austrians, 47 Germans, 5 from other countries; 45±15 years) who had been living with type 1 diabetes for 26±14.5 years participated. The vast majority of participants were insulin pump (and/or glucose sensor) users (84%) and reported good glycemic control (31% with hemoglobin A1c (HbA1c) <7% and 51% with HbA1c 7%-8%). ICT was generally acceptable for counseling, with email/online messaging services and online health platform the most preferred options (74% and 53%). Study participants expressed a neutral to positive attitude toward the combined theme scores (relationship with HCP; confidence using technology; trust in data protection; intrusion of patient privacy; general acceptance of ICT in healthcare). UK participants showed more positive attitudes toward ICT across all theme scores than participants from Austria and Germany, but there were no gender-related differences. Conclusions: This online survey identified a highly ICT-astute group of people with type 1 diabetes, already using technology for insulin delivery, for whom online supported clinical diabetes care would be a viable and welcomed option