Effects of Movement Control Order (MCO) During Covid-19 Pandemic on Patients With Diabetes Mellitus (DM) in Malaysian Tertiary Centers
Authors: Kuan Yueh Chien , Tong Chin Voon , Katiman Elliyyin , Tiong Xun Ting , Chan Pei Lin , Tan Florence , Noor Nurain Mohd 
Published: May 2021

Abstract
Introduction: The Malaysian government implemented MCO or lockdown for nearly 3 months from 18 Mar to 9 Jun 2020 in response to the Covid-19 pandemic. This restricted access to usual food, workplace, and leisure sports, and also led to reduced clinic attendance. The effects of MCO on patients with chronic lifestyle diseases like DM is unknown. Methodology: This is a cross-sectional study exploring effects of MCO on adult (&gt;18 years) DM patients (both Type 1 and Type 2) attending endocrinologist-run DM clinics in 3 tertiary centres in Malaysia. Glycaemic and metabolic parameters were collected through medical record review while data on healthcare utilisation, dietary and lifestyle habits before MCO (17 Nov 2019 to 17 Mar 2020) and during MCO were collected by investigator-administered questionnaires during routine clinic follow-up after the MCO period (10 Jun to 30 Oct 2020). Results: From a total of 207 patients (56.5% female, 73.4% T2D and 80% on insulin) no significant difference between mean (SD) A1c [8.6(2.39) % vs 8.4(2.14) %; p=0.073] or BMI [29.2(7.57) vs 29.4(9.23)kg/m2; p=0.968] were seen before and during MCO respectively. More than 95% of the patients attended clinic before MCO and at least 20.3% saw either the DM nurse educator, DM pharmacist or dietitian. In contrast, during MCO only 31.4% of patients attended clinic and less than 10% had face-to-face consultation with the DM support team. More patients also reported missing insulin (11.6% vs 7.7%) and not checking blood glucose (17.9% vs 15.5%) during MCO. Before MCO, 61.8% of patients had home-cooked food daily. During MCO this increased to 83.1%. However, there was a trend towards unhealthy eating during MCO. Patients reported eating more frequently with those eating more than 4 meals a day nearly tripled during MCO (18.4% vs 6.8%). In addition, 22% of patients recalled consuming more confectionary; a similar percentage also reported higher consumption of processed food like dry snacks, canned food and instant noodles during MCO. Mean (SD) hours of sleep [6.8 (1.35) vs 7.2 (1.73) hours; p&lt;0.001] and screen time [3.3 (2.51) vs 4.51 (3.10] hours, p&lt; 0.001) increased significantly during MCO compared to before. Notably, before MCO 44% of patients reported no exercise and this increased to 65.7% during MCO. Conclusion: Despite reduced clinic attendance and contact with the DM support team, there were no consequent significant change in A1c or BMI of our DM patients from the 3-month MCO in our short term study. However, a worrying increase in sedentariness and unhealthy eating existed. The imperative need to conduct work or lessons online, among others contributed to the inevitable rise in screen time and reduced physical activity. As the pandemic continues with imposed movement restrictions, the long-term implications of MCO to metabolic health warrant our attention. Innovative strategies to promote healthier living during MCO are urgently needed.