Association of the Coronavirus Disease 2019 Outbreak on the Diabetes Self-Management in Chinese Patients: An Analytical Cross-Sectional Study

Figures & data

Table 1 The Demographic Information of the Study Patients

Variable	All Patients (n=872)	Self-Management Compliance		X^2	P
		Good (n=606)	Poor (n=266)
Age, Median (IQR)	58.0(50.0–67.0)	59.0 (50.0–67.0)	59.0(52.0–67.0)		0.118
Female, n (%)	383(43.9%)	272 (44.9%)	111(41.7%)	0.747	0.387
BMI, kg/m^2, n (%)				18.008	<0.001
Underweight (≤18.4)	36(4.1%)	24(4.0%)	12(4.5%)
Normal BMI (18.5–23.9)	416(47.7%)	317(52.3%)	99(37.2%)
Overweight (24.0–27.9)	293(33.6%)	189(31.2%)	104(39.1%
Obese (≥28)	99(11.4%)	58(9.6%)	41(15.4%)
Education, n (%)				6.069	0.108
Primary school and below	228(26.1%)	149(24.6%)	79(29.7%)
Junior high	278(31.9%)	191(31.5%)	87(32.7%)
Senior high	236(27.1%)	165(27.2%)	71(26.7%)
Bachelor and above	130(14.9%)	101(16.7%)	29(10.9%)
Living status, n (%)				5.038	0.81
Live with family	808(92.7%)	568(93.7%)	240(90.2%)
Live lonely	52(6.0%)	29 (4.8%)	23(8.6%)
Other (nursing home, etc.)	12(1.4%)	9(1.0%)	3(0.3%)
Smoking, n (%)	195(22.4%)	124(20.5%)	71(26.7%)	4.132	0.042
Drinking, n (%)	115(13.2%)	72(11.9%)	43(16.2%)	2.964	0.085

Note: We divided patients into two groups based on their self-assessment of diabetes self-management. Chi-square test and Independent-Sample t–Test were used to test for significance.

Abbreviation: BMI, body mass index.

Table 2 Health and Diabetes-Related Variables of Participants (n = 872)

Variable	All Patients (n= 872)	Self-Management Compliance		X^2	P
		Good (n=606)	Poor (n=266)
Diabetes duration, year, median (IQR)	7.0(3.0–12.0)	7.0(3.0–12.0)	10.0(4.0–11.0)		0.94
Received diabetes education, n (%)	643(73.7%)	522(86.1%)	121(45.5%)	157.740	<0.001
Sources of Diabetes Education, n (%)				12.868	0.045
Health professionals	485(37.8%)	390(36.6%)	95(43.8%)
Community health counseling spot	283(22.1%)	243(22.8%)	40(18.4%)
Journals/books	146(11.4%)	122(11.5%)	24(11.1%)
TV/radio	200(15.6%)	169(15.9%)	31(14.3%)
Internet/APPs	144(11.2%)	119(11.2%)	25(11.5%)
Others	24(1.9%)	22(2.1%)	2(0.9%)
Medical history, n (%)				17.885	0.007
None	343(26.5%)	254(28.9%)	89(21.5%)
Hypertension	409(31.7%)	275(31.3%)	134(32.4%)
Cerebrovascular disease	120(9.3%)	77(8.8%)	43(10.4%)
Coronary heart disease	120(9.3%)	75(8.5%)	45(10.9%)
Lipid metabolism abnormal	248(19.2%)	168(19.1%)	80(19.3%)
Others	52(4.0%)	29(3.3%)	23(5.6%)
Diabetic complications, n (%)				6.842	0.446
None	420(34.6%)	294(35.5%)	126(32.7%)
Diabetic foot	35(2.9%)	22(2.7%)	13(3.4%)
Nephropathy	104(8.6%)	68(8.2%)	36(9.4%)
Peripheral vascular disease	134(11.0%)	97(11.7%)	37(9.6%)
Neuropathy	307(25.3%)	211(25.5%)	96(24.9%)
Retinopathy	191 (15.7%)	124(15.0%)	67(17.4%)
Others	23(1.9%)	13(1.6%)	10(2.6%)
Treatment regimen, n (%)				29.994	<0.001
OAD only	449(51.5%)	330(54.5%)	119(44.7%)
Insulin (OR GLP-1)	151(17.3%)	95(15.7%)	56(21.1%)
OAD + insulin (OR GLP-1)	249(28.6%)	177(29.2%)	72(27.4%)
Not on medication treatment	20(2.3%)	4(0.7%)	16(6.0%)
Not available	3(0.3)	0(0.0%)	3(1.1%)

Abbreviations: OAD, oral anti-diabetic drug; GLP-1, glucagon like peptide 1.

Table 3 The Glycemic Control Status of Participants During the COVID-19 Pandemic. (n = 872)

Variable	All Patients (n= 872)	Self-Management Compliance		X^2	P
		Good (n=606)	Poor(n=266)
HbA1c, %, median (IQR)	7.5(6.7–9.2)	7.4(6.5–8.7)	8.1(7.2–10.4)	17.015	<0.001
<7.0%, n (%)	162(18.6%)	137(22.6%)	25(9.4%)
7.0–8.0%, n (%)	127(14.6%)	93(15.3%)	34(12.8%)
>8.0%, n (%)	180(20.6%)	117(19.3%)	63(23.7%)
Not Available, n (%)	403(46.2%)	259(42.7%)	144(54.1%)
FPG, mmol/L, median (IQR)	7.3(6.4–8.8)	7.1(6.3–8.2)	8.4(7.0–10.4)	23.293	<0.001
< 6.1 mmol/L, n (%)	138(15.0%)	113(18.6%)	25(9.4%)
6.1–7.0 mmol/L, n (%)	187(21.4%)	154(25.4%)	33(12.4%)
> 7.0 mmol/L, n (%)	416(47.7%)	276(45.5%)	140(52.6%)
Not Available, n (%)	131(15.0%)	63 (10.4%)	68(25.6%)
PPG, mmol/L, median (IQR)	10.7(9.0–13.2)	10.3(8.9–12.5)	12.0(9.5–15.5)	19.869	<0.001
<8.0 mmol/L, n (%)	55(6.3%)	39(6.4%)	16(6.0%)
8.0–10.0 mmol/L, n (%)	174(20.0%)	150(24.8%)	24(9.0%)
>10.0 mmol/L, n (%)	318(36.5%)	216(35.6%)	102(38.3%)
Not available, n (%)	325(37.3%)	201(33.2%)	124(46.6%)
Hypoglycemia(<3.9mmol/L), n (%)	104(11.9%)	80(13.3%)	24(9.0%)	3.073	0.08
Blood pressure				22.494	<0.001
Good(<140/90mmHg)	518(59.4%)	391(64.5%)	127(47.7%)
Uncontrolled(≥140/90mmHg)	204(23.4%)	128(21.1%)	76(28.6%)
Not available	150(17.2%)	87(14.4%)	63(23.7%)

Notes: For glucose monitoring, approximately 85.0% (n=741), 62.7% (n=547), and 53.8% (n=469) of the patients had FPG, PPG, and HbA1c records, respectively.

Abbreviations: FPG, fasting blood glucose; PPG, postprandial plasma glucose.

Table 4 Impact of Covid-19 Pandemic on Diabetic Self-Management (n=872)

Variable	All Patients (n=872)	Self-Management Compliance		X^2	P
		Good (n=606)	Poor (n=266)
Exercise (days/week), mean (SD)	3.4(2.5)	4.0(2.3)	2.1(2.3)		<0.001
Medication compliance(days/week), mean (SD)	6.3(1.7)	6.6(1.2)	5.8(2.2)		<0.001
Blood glucose testing (days/week), mean (SD)	2.3(1.9)	2.5(1.9)	1.8(1.8)		<0.001
Complications monitoring (days/week), mean (SD)	1.6(2.2)	1.7(2.3)	1.2(2.0)		<0.001
The final mean of diabetes self-management, mean (SD)	3.4(1.3)	3.7(1.2)	2.7(1.3)		<0.001
Reduce the number of visits to hospitals, n (%)	629(72.1%)	455(73.4%)	184(69.2%)	1.668	0.196
Online consultation, n (%)	399(45.8%)	272(44.9%)	127(47.7%)	0.609	0.435
Offline consultation, n (%)	608(69.7%)	448(73.9%)	160(60.2%)	16.622	<0.001
Diabetes-related stress, n (%)	391(44.8%)	289(47.7%)	102(38.3%)	6.525	0.011
Degree of diabetes-related stress(n=286), mean (SD)	5.3(2.8)	5.1(2.8)	6.0(2.8)
Treatment way, n (%)				25.197	<0.001
Community hospital	465(36.2%)	337(36.2%)	128(3639%)
Comprehensive hospital	699(54.5%)	506(54.4%)	193(54.7%)
Buy medicine online	17(1.3%)	11(1.2%)	6(1.7%)
Internet clinic	26(2.0%)	24(2.6%)	2(0.6%)
Mobile phone application	12(0.9%)	9(1.0%)	3(0.8%)
Others	64(5.0%)	43(4.6%)	21(5.9%)

Abbreviation: SD, Standard Deviation.

Table 5 Comparison of Self-Management Data Among Different Variables

Variable	Self-Management Status
	Mean (SD)	P value
Age (year)		0.008
≤60	3.5(1.3)
>60	3.3(1.3)
BMI (kg/m^2)		0.497
Underweight (≤18.4)	3.4(1.8)
Normal BMI (18.5–23.9)	3.4(1.3)
Overweight (24.0–27.9)	3.5(1.3)
Obese (≥28)	3.3(1.4)
Sex		0.102
Female	3.3(1.3)
Male	3.4(1.3)
Education		<0.001
Primary school and below	2.9(1.4)
Junior high	3.5(1.3)
Senior high	3.5(1.2)
Bachelor and above	3.8(1.2)
Living status		0.049
Live with family	3.4(1.3)
Live lonely	3.1(2.0)
Orders (nursing home, etc.)	4.1(1.9)
Diabetes duration (year)		0.070
<5	3.4(1.2)
5–10	3.3(1.4)
11–15	3.3(1.3)
16–20	3.8(1.5)
>20	3.3(1.4)
Received diabetes education		<0.001
Yes	3.6(1.3)
No	3.0(1.4)
Self-assessment of diabetes self-management		<0.001
Good	3.7(1.2)
Poor	2.7(1.3)
Complication		0.115
Absent	3.4(1.4)
Present	3.3(1.2)
Comorbidities		0.014
Absent	3.5(1.4)
Present	3.3(1.2)
Online consultation		0.012
Yes	3.5(1.4)
No	3.3(1.2)
HbA1c, %		<0.001
<7.0%	3.6(1.2)
7.0–8.0%	3.5(1.4)
>8.0%	3.0(1.1)

Note: Nonparametric Test and One-way ANOVA were used.