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Aims: Our study examined changes in average blood glucose levels (ABG), measurement frequency (MF), and data uploading (DU) before and during the COVID-19 pandemic in 882-day spans, which were divided into further 20-week intervals to highlight the pandemic's impact., Methods: T-Tests assessed the statistical significance of blood glucose data from 26,655/20,936 patients and 19.5/16.6 million records during pre-COVID/COVID., Results: During COVID, patients had significantly lower ABG levels (9.1/8.9 mmol/L, p < 0.001). Weekly DU decreased (155,945/128,445, p < 0.05), while daily MF increased (0.83/0.87, p < 0.001). Comparing the last 20 weeks pre-COVID to the first 20 weeks during COVID, ABG levels were lower (9.0 /8.9, p < 0.01), MF increased (0.83 /0.99, p < 0.001), and DU decreased (153,133/145,381, p < 0.05). In the initial 20 weeks of COVID compared to the second 20 weeks of COVID, ABG increased (8.9/9.1, p < 0.01), MF decreased (0.99/0.95, p < 0.001), and DU decreased (145,381/140,166, p < 0.05). Our most striking observation was the temporary dramatic fall in glucose uploads during the first few weeks of COVID. The changes of ABG and MF values were statistically significant, but were not deemed clinically relevant., Conclusions: Despite COVID's prolonged impact, diabetic patients showed improved attitudes. A significant drop in data uploads occurred during the first 20 weeks of COVID; home office and lockdowns apparently disrupted patient routines., Competing Interests: Declaration of competing interest The authors declare that the research was conducted without any commercial or financial relationships that could be perceived as potential conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Cardiovascular autonomic neuropathy (CAN) is a frequent complication of diabetes mellitus and is associated with increased morbidity and mortality in patients with diabetes. Hence, early and correct diagnosis of CAN is crucial. Standard cardiovascular reflex rests (CARTs) have been the gold standard of CAN assessment. Originally, CARTs consisted of five reflex tests, but measuring diastolic blood pressure response to sustained handgrip exercise has no longer been suggested as an established clinical test. Increasing body of evidence suggests that isometric handgrip test should no longer be used for the evaluation of sympathetic dysfunction during cardiovascular autonomic neuropathy assessment in diabetic patients. The associations of isometric handgrip test results with parameters of hypertension and markers of hypertension-related target-organ damage in diabetic and non-diabetic individuals point toward its potential role as a screening tool to identify patients with high cardiovascular risk. The current review summarizes historical view of standard cardiovascular reflex tests and latest data on isometric handgrip test., Competing Interests: Declaration of competing interest The authors have no conflicting interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)