Self-care in migrant patients with type 2 diabetes during the COVID-19 pandemic.
Authors: Pettersson S , Jaarsma T , Hedgard K , Klompstra L 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The risk of cardiovascular disease is increased in persons with diabetes. Type 2 diabetes is increasing globally and affects particularly vulnerable groups in society, such as migrants. Research shows that type 2 diabetes is a risk factor for severe illness when affected by Covid-19. Good glycaemic control has been shown to be an important cornerstone for preventing diabetes related complications but also severe illness for persons being affected with Covid-19. In order to maintain a good glycemic control, self-care is needed.

Purpose
To describe self-care and possible changes during the COVID-19 pandemic in migrant patients with type 2 diabetes. We also aimed to describe how patients would like to receive information from health care and to explore the need of support during the pandemic.

Method
In this cross-sectional study, quantitative and qualitative data were collected and interpreted together in a triangulation design. A questionnaire was translated into the most common languages used at the primary clinic and sent out to 332 migrant patients, diagnosed with type 2 diabetes and treated in primary care. This questionnaire assessed self-care maintenance in diabetes (questions inspired on the Self-Care of Diabetes Inventory), where questions were added for every item to assess change during the pandemic. When changes occurred, we asked patients to elaborate. With open ended questions, patients were asked how they would like to receive information when there are changes in health care. Descriptive statistical analysis were used for quantitative data and qualitative data was analyzed with a directed approach to content analysis.

Results
In total 79 patients answered the questionnaire (mean age 69 ±11, 51 % male, born in the Middle East 43 %). Of the patients, 84 % expressed a change in self-care. More than half (58%) expressed change in maintaining an active lifestyle, 40% changed their physical exercise and 38% changed their behaviour in avoiding getting sick (Figure 1). Patients felt that this change was due to staying home as they feared meeting people during the pandemic or canceled social activities. Others were more regular physical active, like taking walks to get fit, as a precaution related to Covid-19 and having higher awareness in how to avoid getting sick. One fourth of the patients experienced a change in contact with the health care due to fewer doctor’s appointments and care being postponed. More than half (58%) of the patients prefered to receive information by a written letter. Social support changed for 35% of the patients with less support from family and friends due to risk of being infected by Covid-19.

Conclusions
Migrant patients with type 2 diabetes express both positive and negative changes during the Covid-19 pandemic in self-care. Support for optimal self-care is vital and there is a need for feeling safe with more information from health care providers and check-ups more often during a pandemic.