Awareness regarding COVID-19 and problems being faced by young adults with type 1 diabetes mellitus amid nationwide lockdown in India: A qualitative interview study

  • Author Footnotes
    1 Both Rimesh Pal and Urmila Yadav to be considered as first authors.
    Rimesh Pal
    Footnotes
    1 Both Rimesh Pal and Urmila Yadav to be considered as first authors.
    Affiliations
    Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
    Search for articles by this author
  • Author Footnotes
    1 Both Rimesh Pal and Urmila Yadav to be considered as first authors.
    Urmila Yadav
    Footnotes
    1 Both Rimesh Pal and Urmila Yadav to be considered as first authors.
    Affiliations
    National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
    Search for articles by this author
  • Anmol Verma
    Affiliations
    Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
    Search for articles by this author
  • Sanjay K. Bhadada
    Correspondence
    Corresponding author.
    Affiliations
    Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
    Search for articles by this author
  • Author Footnotes
    1 Both Rimesh Pal and Urmila Yadav to be considered as first authors.

      Highlights

      • Young adults with T1DM lacked adequate awareness about COVID-19.
      • Prevailing lockdown had reduced the routine physical activity of people with T1DM.
      • Suboptimal glucose control could be linked to reduction in physical activity.

      Abstract

      Aims

      To assess the awareness about COVID-19 and the problems being faced by young adults with T1DM amid nationwide lockdown in India.

      Methods

      A cross-sectional telephone-based qualitative interview study was conducted in young adults (aged 18–30 years) with T1DM amid lockdown. Following verbal consent, participants were asked 8 open-ended questions, 5 on awareness about COVID-19 and 3 catering to problems being faced concerning diet, physical activity and treatment amid lockdown. On average, 3 interviews were conducted per day with each lasting for 15−20 min. Interviews were recorded, transcribed and analyzed by qualitative content analysis.

      Results

      Thirty-two participants were interviewed; after exclusion of two poorly recorded interviews, 30 were finally analyzed. Mean age of participants was 22.4 ± 4.0 years (M:F = 8:7). Only 30%, 40% and 53% of participants were aware of modes of transmission (respiratory droplets and fomites), cardinal symptoms (fever, cough and breathing difficulty) and means of prevention (staying indoors, social distancing and regular hand washing), respectively. Majority of participants were unaware of additional risks associated with COVID-19 in diabetes mellitus. Most participants could continue with their routine diet and prescribed treatment regime, however, 90% reported a reduction in physical activity and 72% experienced worsening of glycemic control amid lockdown.

      Conclusions

      Young adults with T1DM lack adequate awareness about COVID-19. Increasing awareness and imparting diabetes self-management education via digital/print media is needed.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Coronavirus disease (COVID-19) Situation Report – 126 [Internet]. [cited 26 May 2020]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200525-covid-19-sitrep-126.pdf?sfvrsn=887dbd66_2.

        • Guan W.
        • Ni Z.
        • Hu Y.
        • et al.
        Clinical characteristics of coronavirus disease 2019 in China.
        N. Engl. J. Med. 2020; 382: 1708-1720
        • Onder G.
        • Rezza G.
        • Brusaferro S.
        Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy.
        JAMA [Internet]. 2020; ([cited 2020 Mar 24]; Available from:)
        • Pal R.
        • Bhadada S.K.
        COVID-19 and non-communicable diseases.
        Postgrad. Med. J. 2020; (postgradmedj-2020-137742)
        • Pal R.
        • Bhansali A.
        COVID-19, diabetes mellitus and ACE2: the conundrum.
        Diabetes Res. Clin. Pract. 2020; 162: 108132
        • Cariou B.
        • Hadjadj S.
        • Wargny M.
        • et al.
        Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study.
        Diabetologia [Internet]. 2020; ([cited 2020 May 31]; Available from:)
        • Pal R.
        • Bhadada S.K.
        Should anti-diabetic medications be reconsidered amid COVID-19 pandemic?.
        Diabetes Res. Clin. Pract. 2020; 163: 108146
        • Banerjee M.
        • Chakraborty S.
        • Pal R.
        Diabetes self-management amid COVID-19 pandemic.
        Diabetes Metab. Syndr. 2020; 14: 351-354
        • Wolf M.S.
        • Serper M.
        • Opsasnick L.
        • et al.
        Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: a cross-sectional survey.
        Ann. Intern. Med. [Internet]. 2020; ([cited 2020 Apr 18]; Available from:)
        • Xue T.
        • Li Q.
        • Zhang Q.
        • et al.
        Blood glucose levels in elderly subjects with type 2 diabetes during COVID-19 outbreak: a retrospective study in a single center.
        medRxiv [Internet]. 2020; ([cited 2020 Apr 8]. Available from:)https://doi.org/10.1101/2020.03.31.20048579
        • Patton S.R.
        Adherence to diet in youth with type 1 diabetes.
        J. Am. Diet. Assoc. 2011; 111: 550-555
        • Michaliszyn S.F.
        • Shaibi G.Q.
        • Quinn L.
        • et al.
        Physical fitness, dietary intake, and metabolic control in adolescents with type 1 diabetes.
        Pediatr. Diabetes. 2009; 10: 389-394
        • Berlin K.S.
        • Rabideau E.M.
        • Hains A.A.
        Empirically derived patterns of perceived stress among youth with type 1 diabetes and relationships to metabolic control.
        J. Pediatr. Psychol. 2012; 37: 990-998
        • Yazidi M.
        • Chihaoui M.
        • Chaker F.
        • et al.
        Factors predicting glycemic control in type 1 diabetic patient.
        Open Med. J. 2016; 3: 153-158
        • Svedbo Engström M.
        • Leksell J.
        • Johansson U.-B.
        • Gudbjörnsdottir S.
        What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register.
        BMJ Open. 2016; 6e010249
        • Gillani S.W.
        • Sulaiman S.A.S.
        • Abdul M.I.M.
        • Saad S.Y.
        A qualitative study to explore the perception and behavior of patients towards diabetes management with physical disability.
        Diabetol. Metab. Syndr. 2017; 9: 58
        • Senior E.
        • Fong R.
        • Christian A.
        • et al.
        Impacts of type 1 diabetes on patients during the first two years—a qualitative research study.
        Diabetes. 2018; 67 (2338-PUB)
        • Fink A.
        • Fach E.-M.
        • Schröder S.L.
        ‘Learning to shape life’ – a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2.
        Int. J. Equity Health. 2019; 18: 19
        • Smith D.M.
        • Donnelly P.J.
        • Howe J.
        • et al.
        A qualitative interview study of people living with well-controlled Type 1 diabetes.
        Psychol. Health. 2018; 33: 872-887
        • Loerbroks A.
        • Nguyen X.Q.
        • Vu-Eickmann P.
        • et al.
        Psychosocial working conditions and diabetes self-management at work: a qualitative study.
        Diabetes Res. Clin. Pract. 2018; 140: 129-138
        • Abdoli S.
        • Hessler D.
        • Vora A.
        • et al.
        Experiences of diabetes burnout a qualitative study among people with type 1 diabetes.
        Am. J. Nurs. 2019; 119: 22-31
        • Novick G.
        Is there a bias against telephone interviews in qualitative research?.
        Res. Nurs. Health. 2008; 31: 391-398
        • Musselwhite K.
        • Cuff L.
        • McGregor L.
        • et al.
        The telephone interview is an effective method of data collection in clinical nursing research: a discussion paper.
        Int. J. Nurs. Stud. 2007; 44: 1064-1070
        • Stephens N.
        Collecting data from elites and ultra elites: telephone and face-to-face interviews with macroeconomists.
        Qual. Res. 2007; 7: 203-216
        • Lechuga V.M.
        Exploring culture from a distance: the utility of telephone interviews in qualitative research.
        Int. J. Qual. Stud. Educ. 2012; 25: 251-268
        • Drabble L.
        • Trocki K.F.
        • Salcedo B.
        • et al.
        Conducting qualitative interviews by telephone: lessons learned from a study of alcohol use among sexual minority and heterosexual women.
        Qual. Soc. Work Res. Pract. 2016; 15: 118-133
        • Trier-Bieniek A.
        Framing the telephone interview as a participant-centred tool for qualitative research: a methodological discussion.
        Qual. Res. 2012; 12: 630-644
        • Graneheim U.H.
        • Lundman B.
        Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.
        Nurse Educ. Today. 2004; 24: 105-112
        • Schreier M.
        Qualitative content analysis.
        The SAGE Handbook of Qualitative Data Analysis [Internet]. SAGE Publications Ltd., 1 Oliver’s Yard, 55 City Road, London EC1Y 1SP United Kingdom2014: 170-183 ([cited 2020 Jun 2]Available from:)
        • Guan W.
        • Liang W.
        • Zhao Y.
        • et al.
        Comorbidity and its impact on 1590 patients with Covid-19 in China: a nationwide analysis.
        Eur. Respir. J. 2020; 55: 2000547
        • Zhong B.-L.
        • Luo W.
        • Li H.-M.
        • et al.
        Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey.
        Int. J. Biol. Sci. 2020; 16: 1745-1752
        • Braveman P.
        Accumulating knowledge on the social determinants of health and infectious disease.
        Public Health Rep. 2011; 126: 28-30
        • Labban L.
        • Thallaj N.
        • Labban A.
        Assessing the level of awareness and knowledge of COVID 19 pandemic among syrians.
        Arch. Med. 2020; 12: 8
        • Akalu Y.
        • Ayelign B.
        • Molla M.D.
        Knowledge, attitude and practice towards COVID-19 among chronic disease patients at Addis Zemen Hospital, Northwest Ethiopia.
        Infect. Drug Resist. 2020; 13: 1949-1960
        • Kebede Y.
        • Yitayih Y.
        • Birhanu Z.
        • et al.
        Knowledge, perceptions and preventive practices towards COVID-19 early in the outbreak among Jimma university medical center visitors, Southwest Ethiopia.
        PLoS One. 2020; 15e0233744
      2. State of Literacy. [Internet]. [cited 30 April 2020]. Available from: https://censusindia.gov.in/2011-prov-results/data_files/india/Final_PPT_2011_chapter6.pdf.

        • Ghosh A.
        • Gupta R.
        • Misra A.
        Telemedicine for diabetes care in India during COVID19 pandemic and national lockdown period: guidelines for physicians.
        Diabetes Metab. Syndr. 2020; 14: 273-276
        • Banerjee M.
        • Chakraborty S.
        • Pal R.
        Teleconsultation and diabetes care amid COVID-19 pandemic in India: scopes and challenges.
        J. Diabetes Sci. Technol. 2020; (193229682092939)
        • Ruiz de Adana M.S.
        • Alhambra-Expósito M.R.
        • Muñoz-Garach A.
        • et al.
        Randomized study to evaluate the impact of telemedicine care in patients with type 1 diabetes with multiple doses of insulin and suboptimal HbA1c in Andalusia (Spain): PLATEDIAN study.
        Diabetes Care. 2020; 43: 337-342
        • Colberg S.R.
        • Sigal R.J.
        • Yardley J.E.
        • et al.
        Physical activity/exercise and diabetes: a position statement of the American diabetes association.
        Diabetes Care. 2016; 39: 2065-2079
        • Roy T.
        • Lloyd C.E.
        Epidemiology of depression and diabetes: a systematic review.
        J. Affect. Disord. 2012; 142: S8-21
        • Raval A.
        • Dhanaraj E.
        • Bhansali A.
        • et al.
        Prevalence and determinants of depression in type 2 diabetes patients in a tertiary care centre.
        Indian J. Med. Res. 2010; 132: 195-200
        • American Diabetes Association
        5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes—2020.
        Diabetes Care. 2020; 43: S48-S65