Effect of Covid-19 on people with diabetes
Mr Ranjan Rajendram | GR001223
The Covid-19 pandemic has caused significant disruption to routine clinical services across the UK. We’re co-funding, with Diabetes UK, a project looking at the effects of deferring treatment of diabetic macular oedema (DMO) patients.
During the pandemic and into the recovery phase, clinical services utilise well-grounded approaches to ensure the most appropriate care pathways are implemented for patients.
This would include risk stratification used in prioritising appointments, the use of video A&E and clinics and the support services made available to patients (including website self-care content and a nurse-led helpline in case patients’ symptoms change.
Diabetic macular oedema (DMO) is a leading cause of visual impairment in diabetes. Early detection and timely treatment form the cornerstones of management, and help prevent permanent visual loss from this condition.
In the UK, people with DMO are routinely treated with periodic intra-ocular injections of antiVEGF. This procedure works by helping to reduce abnormal fluid build-up caused by leaky blood vessels at the back of the eye.
Diabetic macular oedema (DMO)
Diabetic macular oedema (DMO) is the most common cause of sight loss in people with diabetes. Oedema means fluid retention. When leaky vessels cause fluid to build up at the centre area of the retina, it is known as diabetic macular oedema. It results in a condition very similar to wet AMD.
Several clinical trials have confirmed the effectiveness of such advanced treatments. There is also some evidence to suggest that premature interruption to such treatment can lead to adverse consequences for vision among people with diabetes.
The ongoing Covid-19 pandemic has caused significant - albeit temporary - disruption to routine clinical services across the UK, including monthly anti-VEGF injections for DMO.
Finding a solution
Ranjan Rajendram and colleagues will investigate the effects of this disruption on the visual health of people living with diabetes.
To do this, they will study individuals with DMO who were scheduled to have antiVEGF injections but who had their treatment deferred due to the pandemic.
Patients will be assessed at their next clinical appointment and their vision will be assessed using standard clinical tools as well as advanced techniques of investigation such as optical coherence tomography – to visualise the back of the eye.
This study aims to provide robust and timely information regarding the effects of treatment interruption. It will also establish a strong, scientific rationale to help guide future management of individuals with DMO during these extra-ordinary times.
These findings could help serve as a useful benchmark for future risk assessment strategies, enabling appropriate resource allocation and planning. This could in turn pave way for the development of novel clinical pathways of uninterrupted care for these at-risk individuals during pandemic periods - a model that may hold potential to be adapted to other routine clinical services in the NHS.
Diabetes UK is delighted to co-fund this research, alongside Moorfields Eye Charity. With DMO being one of the leading causes of loss of vision in people with diabetes, it is key that we understand what impact the Covid-19 pandemic has had on the eye health of people with this condition as missed checks and treatments can have devastating consequences.
Dr Elizabeth Robertson, Director of Research at Diabetes UK
Mr Ranjan Rajendram