Document Type : Original Article

Authors

1 Department of Information Technology, Thakur college of Engineering and Technology, Mumbai, Maharashtra, India

2 Department of Computer Engineering, Terna Engineering College, Navi Mumbai, Maharashtra, India

3 Department of Information Technology, Thakur College of Engineering and Technology, Mumbai, Maharashtra, India

4 Department of Pharmacology, MGM Medical College, Aurangabad/ Maharashtra/ India

Abstract

Background: Evaluation of the impact of stress on glycaemic control in hospitalized type-2 diabetes (T2DM) patients with coronavirus disease (COVID-19).
Methods: In this retrospective study conducted at a single centre in Maharashtra from May to July 2020 on hospitalized COVID-19 patients with T2DM who reported having stress of pandemic; they were selected using purposive sampling. DASS-12 stress sub-scale was used to estimate the severity of their stress. Fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) before admission and at the time of discharge were compared.
Results: One hundred and ninety-nine patients (mean age 54 years; 61.30% females) were included. Mean±SD FBG before admission was 168.4±30.6 mg/dl which increased to 195.9±28.8 mg/dl at the time of discharge (P<0.001). Also, Mean±SD PPBG before admission was 312±62.3 mg/dl which increased to 351.6±61.9 mg/dl (P<0.001). A total of 73 (36.7%) participants had perceived stress. Moderate and severe/extremely severe stress was found in 44 (27.1%) and 19 (9.6%) patients, respectively. A significant difference was observed in the mean FBG before and during discharge in patients who had no stress and those with moderate stress (P<0.001). There was no difference in FBG in patients with severe/extremely severe stress (P=0.43). Similar observations were seen for PPBG (no stress P<0.001; moderate stress P<0.001; severe/extremely severe stress P=0.06).
Conclusion: There was a rise in the glucose level in T2DM patients discharged after COVID-19 treatment. The increase was significant in T2DM without stress and those with moderate stress. In addition to traditional treatment, measures for psychological stress control should also be taken for such patients.

Keywords

  1. IDF SEA members. https://idf.org/our-network/regions-members/south-eastasia/members/94-india.html assessed on 4th April 2021.
  2. Saeedi P, Petersohn I, Ssalpea P, Malanda B, Karuranga S, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9 th Diabetes Res Clin Pract. 2019;157:107843.
  3. Harris ML, Oldmeadow C, Hure A, Luu J, Loxton D, et al. Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PLoS One. 2017;12:
  4. Marcovecchio ML, Chiarelli F. The effects of acute and chronic stress on diabetes control. Sci Signal. 2012;5:pt10.
  5. Schofield J, Leelarathna L, Thabit H. COVID-19: Impact of and on diabetes. Diabetes Ther. 2020;11:1429-1435.
  6. Joensen LE, Madsen KP, Holm L, Nielsen KA, Rod MH, et al. Diabetes and COVID-19: psychosocial consequences of the COVID-19 pandemic in people with diabetes in Denmark-what characterizes people with high levels of COVID-19-related worries?. Diabet Med. 2020;37:1146-1154.
  7. Sankar P, Ahmed WN, Koshv VM, Jacob R, Sasidharan S. Effects of COVID-19 lockdown on type 2 diabetes, lifestyle and psychosocial health: A hospital-based cross-sectional survey from South India. Diabetes Metab Syndr. 2020;14:1815-1819.
  8. Yusoff MSB. Psychometric Properties of the Depression Anxiety Stress Scale in a Sample of Medical Degree Applicants. Int Med J. 2013; 20: 295-300.
  9. Ruissen MM, Regeer H, Landstra CP, Schroijen M, Jazet I, Nijhoff MF, et al. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic. BMJ Open Diab Res Care 2021;9:e002035. doi:10.1136/ bmjdrc-2020-002035
  10. Kautzky-Willer A. Does diabetes mellitus mitigate the gender gap in COVID-19 mortality? European Journal of Endocrinology 2021; 185:C13–C17
  11. Yoshida Y, Gillet SA, Brown MI, Zu Y, Wilson SM, Ahmed SJ, et al. Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans. Biol Sex Differ 2021;12:20
  12. Dasappa H, Fathima FN, Prabhakar R, Sarin S. Prevalence of diabetes and pre-diabetes and assessments of their risk factors in urban slums of Bangalore. J Family Med Prim Care. 2015;4:399-404.
  13. Hilliard ME, Yi-Frazier JP, Hessler D, Butler AM, Anderson BJ, et al. Stress and A1c among people with diabetes across the lifespan. Curr Diab Rep. 2016;16:67.
  14. Peric S, Stulnig TM. Diabetes and COVID-19. Disease—Management—People. Wien Klin Wochenschr. 2020; May 20 : 1–6.
  15. Tanji Y, Sawada S, Watanabe T, Mita T, Kobayashi Y, Murakam T, et al. Impact of COVID-19 pandemic on glycemic control among outpatients with type 2 diabetes in Japan: A hospital-based survey from a country without lockdown. Diabetes research and clinical practice 2021; 176: 108840
  16. Faulenbach M. Uthoff H, Schwegler K, Spinas GA, Schmid C, Wiesli P.Effect of psychological stress on glucose control in patients with Type 2 diabetes. Diabetes Med 2012;29:128-31
  17. Vasanth R, Ganesh A, Shanker R. Impact of stress on type 2 diabetes mellitus management. Psychiatr Danub. 2017;27 (Suppl 3):416-421.
  18. Abdi A, Jalijian M, Sarbarzeh PA, Vlaisavlievic Z. Diabetes and COVID-19: A systematic review on the current evidences. Diabetes Res Clin Pract. 2020;166:108347.
  19. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020;14:303-310.
  20. Wong H, Singh J, Go RM, Ahluwalia N, Guerrero-Go MA. The effects of mental stress on non-insulin-dependent diabetes: Determining the relationship between catecholamine and adrenergic signals from stress, anxiety, and depression on the physiological changes in the pancreatic hormone secretion. Cureus. 2019;11:e5474.
  21. Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health. 2020;16:57.
  22. Lim S, Bae JH, Kwon H-S, Nauck MA. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol. 2021;17:11-30.
  23. Erener S. Diabetes, infection risk and COVID-19. Mol Metab. 2020; 39: 101044.