Understanding impacts of COVID-19 restrictions on glycemic control for patients with diabetes in Japan.

Objective: This study evaluated the changes in the status of glycemic control and lipid management in patients with diabetes under COVID-19 containment restrictions, in order to better understand the impacts of events causing lifestyle restrictions. Patient characteristics with worsened glycemic control were also assessed. Methods: We conducted a retrospective and observational cohort study using the electronic health records of 5,169 patients with diabetes seeking medical care in two healthcare centers. Laboratory test results including glycemic and lipid goal attainment rates were compared between pre-COVID-19 (January to December 2019) and the first wave of COVID-19 (February to June 2020). Multiple regression models were used to evaluate the association between glycated hemoglobin (HbA1c) at baseline and during the first wave with covariates such as concomitant medications and comorbidities. Results: The HbA1c goal achievement rate improved significantly from 39.0% to 43.1% (p < 0.0001) overall, and more patients reached their glycemic target during COVID-19 restrictions. No significant changes were observed in lipid control. An indexed change in HbA1c level showed that glycemic control improved in 2,230 patients and worsened in 1,619 patients. Administration of insulin, GLP-1, and sulfonylureas were each identified as factors correlated with elevated HbA1c, during the first wave of COVID-19. Conclusion: Although the glycemic control in patients with diabetes improved overall under COVID-19 restrictions, those on insulin, GLP-1, or sulfonylureas worsened. These findings suggest the need to better understand what drives differences in glycemic control to better support people with diabetes for future epidemiological outbreaks. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01302-5.

Complete removal of endometriosis improves fecundity.

Endometriosis is one of the causative factors of impaired fecundity. Whatever the mechanisms are of this impairment, surgical removal of endometriosis appears to increase postoperative fecundity. Our strategy in laparoscopic surgery for symptomatic endometriosis is to completely remove endometriosis. However, despite this strategy, laparoscopic surgery nonetheless creates two categories of patients; complete and incomplete surgery groups. We found by comparing the two groups that both were comparable in terms of fecundity during the early postoperative phase, whereas unlike the complete surgery group, fecundity in the incomplete surgery group stayed low during the late postoperative phase. Deep rectal endometriosis and deeply invading pelvic endometriosis are conditions wherein complete removal of endometriosis is difficult. We have developed laparoscopic surgeries for these conditions: laparoscopic anterior rectum slicing (LARS) and laparoscopic pelvic wall slicing (LPWS) operations, respectively. Both operations are effective in alleviating disease-related symptoms with minimal surgical invasiveness.