Management of obese Type1 Diabetes Mellitus (Double Diabetes) through Telemedicine during COVID 19 pandemic lockdown
Author(s): Swar Sunil Gupta*, Sangeeta Totade, Kavita Gupta, Parvinder Bamrah, Shlok Gupta, Sunil Gupta
Introduction: Prevalence of obesity in type 1DM (T1DM), with features of type 2DM (double diabetes) is increasing, which is an independent risk factor for vasculopathy. Achieving glycaemic control, avoiding insulin-related weight gain and preventing hypoglycemia is challenging in such cases during pandemic. Telemedicine may be effectively used for therapeutic diabetes education. Aim: To manage a case of morbidly obese uncontrolled T1DM, through intensive online lifestyle modification (LSM), during COVID19 lockdown. Case Details: A 33year old morbidly obese female (BMI: 30.1Kg/m2) with T1DM of 24 years duration, having sedentary lifestyle, presented with uncontrolled diabetes (HbA1c-8.7%), despite high total daily dose (TDD) of insulin (140U/Day), limitation of movements, easy fatigue and emotional instability. She had polycystic ovarian syndrome with hypertension and was on metformin, voglibose & telmisartan. First teleconsultation was done in September 2020. Methodology: Teleconsultation for medical nutrition therapy (MNT), exercise, insulin dose adjustments through self-monitoring of blood glucose was done by nutritionist, diabetes educator (DE) and clinician. Modification in total calories intake (reduced by 500-600Kcals/day), food frequency and macronutrient content were done. Regular brisk walk/jogging (45-50mins/day) was advised. Depression was assessed by using PHQ9 questionnaire. Compliance was assessed weekly by DE. Results: At 16 weeks post-intervention, she lost 11.5% of weight. HbA1c reduced by 1% from baseline and TDD of insulin reduced by 57.14%, with no episode of hypoglycemia or ketosis. PHQ9 questionnaire score reduced from 6 to 2. Conclusion: Implementing diabetes education through telemedicine can help to reduce obesity, glycosylated HbA1c, insulin doses and risk of depression in a person with double diabetes.