Governance Organization

SMH – St. Michael’s Hospital Medical Services Organization

Project Title

SMH-20-039 – COVID-19 and diabetes: Clinical Outcomes and Navigated NEtwork Care Today, the CONNECT study

Project Highlights

Diabetes has been implicated as a major risk factor for poor health outcomes among those with COVID-19 in numerous studies. The epidemiology of COVID-19 and diabetes has been fairly well established thus far. However, the psychosocial consequences of the COVID-19 pandemic, especially among people with diabetes (PwD), have not yet been examined to the extent that epidemiological constructs such as mortality have. Of importance, many areas, including Ontario, temporarily delayed in-person consultations and adopted telemedicine for diabetes care. As diabetes is an illness where regular access to care and support from both healthcare professionals and support networks play an important role in disease management, PwD are inevitably more susceptible to COVID-related psychosocial distress (hereafter COVID distress), which could have severe consequences such as an increased risk of psychiatric illnesses. Our study therefore examined many important yet under-investigated topics related to PwD during the pandemic, namely the interplay between social determinants of health and psychosocial well-being, as well as the identification of clinically actionable targets for intervention to reduce pandemic-related distress. To address each of our objectives, we conducted a mixed-methods study involving qualitative interviews to explore any disparities in the experiences of high-risk subgroups of PwD and an online cross-sectional survey to evaluate diabetes-related psychosocial constructs which may be associated with pandemic-related distress. Our interviews showed the importance of social determinants of health. We identified contrasting experiences of: (1) white vs non-white participants; (2) participants of high SES vs low SES; (3) participants with type 1 vs type 2 diabetes; and (4) females vs males. Participants with type 1 diabetes were minimally impacted by the pandemic and used more problem-focused management strategies to confront stressors compared to participants with type 2 diabetes. Non-white participants were more accepting of the pandemic and relied on their support network and faith-based strategies to manage stressors. Participants of high SES perceived the COVID-19 pandemic as less negative and were better positioned to adapt to the pandemic compared to participants of low SES. Females perceived the impact of the pandemic as more negative but used problem-focused stress management methods to actively improve their wellbeing and health. Our results highlight the importance of sociodemographic characteristics of the individual on perceptions of the pandemic and utilization of strategies to manage stressors. The perceptions of the impacts of the pandemic and management strategies differed between groups, with some groups being disproportionately negatively affected, supporting the notion that COVID-19 does not affect everyone equally. These results indicate a need for studies investigating factors associated with psychosocial wellbeing to guide service and interventions. Following this observation, we conducted an observational cross-sectional study and found strong evidence that higher levels of resilient coping and diabetes self-efficacy, and lower levels of diabetes distress were significantly associated with lower levels of COVID distress. Through our mixed-methods study, we examined how sociodemographic characteristics shaped PwD’s experiences of the pandemic, and potential avenues for mitigating the negative impacts of the pandemic. Clinicians and educators can therefore target resilient coping, diabetes self-efficacy, and diabetes distress to minimize distress experienced by PwD from the pandemic. This study therefore highlights the need to evaluate and contextualize the psychosocial wellbeing of PwD at routine check-ups.


Mental Health and Well-Being

Project Leads for Contact

Catherine Yu, Andrew Advani, Gillian Booth


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