Impact of COVID-19 pandemic on HbA1c management and results in pediatric and adult outpatients with diabetes.

Objectives: Diabetes mellitus intensify the risks and complications related to COVID-19 infection. A major effect of the pandemic has been a drastic reduction of in-person visits. The aim of this study was to evaluate the impact of the COVID-19 pandemic on HbA1c management and results among pediatric and adult outpatients with diabetes, considering the laboratory and point-of-care testing (POCT) HbA1c measurements. Methods: Observational retrospective study including patients from pediatric and adult diabetes units was conducted. HbA1c results obtained in the laboratory and POCT over 3 years (2019-2021) were collected from the laboratory information system. Results: After the lockdown, the number of HbA1c plummeted. Children returned soon to routine clinical practice. The number of HbA1c increased gradually in adults, especially in POCT. Globally, HbA1c results were lower in children compared with adults (p<0.001). HbA1c values in children (p<0.001) and adults (p=0.002) decreased between pre-pandemic and post-pandemic periods, though lower than the HbA1c reference change value. The percentage of HbA1c results above 8% remained stable during the study period. Conclusions: Continuous glucose monitoring and a telemedicine have been crucial, even allowing for improvements in HbA1c results. During the lockdown, patients with better metabolic control were managed in the laboratory whereas patients with poorer control or a severe clinical situation were attended in diabetes units by POCT. Adults returned to pre-pandemic management slowly because they were more susceptible to morbidity and mortality due to COVID-19. Coordination among all health professionals has been essential to offering the best management, especially in difficult scenarios such as the COVID-19 pandemic.

Algo viejo, algo nuevo y ¿algo lento? / Something old, something new and something slow?

La fibrilación auricular (FA) es la arritmia más frecuente en la práctica clínica. Es responsable de una elevada morbilidad y mortalidad. Un paciente con FA conocida, que sigue tratamiento adecuadamente, y comienza con mareo, debe alertar al Médico de Familia. Un electrocardiograma es fundamental para un correcto diagnóstico: la presencia de una bradicardia en un paciente con FA. Esta situación clínica constituye una causa de derivación hospitalaria no demorable para realizar estudio etiológico y tratamiento adecuado ante la gravedad del cuadro clínico (AU)

Atrial fibrillation (AT) is the most frequent type of arrhythmia in clinical practice. It causes a high rate of morbidity and mortality. A patient with known AF who follows adequate therapy and starts feeling dizzy, should alert his/her GP. An electrocardiogram is essential for correct diagnosis: the presence of bradycardia in a patient with AF. This clinical situation constitutes a non-delayable reason to refer the patient to the hospital in order to carry out an etiologic study and adequate therapy because of the seriousness of this clinical picture (AU)

¿Dónde está la garrapata? Crucero & casa (resuelto en Atención Primaria) / Where is the tick? Cruise & home (resolved in primary health care)

Trabajar en Atención Primaria supone pensar en las patologías más frecuentes que se dan en nuestro entorno. Un paciente joven que presenta úlceras genitales nos hace pensar en una infección de transmisión sexual. Sin embargo, la falta de respuesta al tratamiento empírico correcto y los resultados de la serología muestran el diagnóstico definitivo: fiebre botonosa mediterránea, con una localización poco común. Debemos recordar que una enfermedad común en nuestro medio puede parecerse a otra igualmente común, por lo que una correcta historia clínica será fundamental para distinguirlas (AU)

Working in primary health care means thinking about the most common pathologies which we encounter in our workplace. A young patient with genital ulcers makes us think of a sexually transmitted infection. However, the lack of response to the correct empirical treatment and serology results show a definitive diagnosis: Mediterranean spotted fever (also known as boutonneuse fever), with a rare location. It should be remembered that a commonly occurring disease in our environment may resemble another equally common one, thus a correct clinical history is fundamental in order to distinguish them (AU)