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ABSTRACT Objective To identify predictors of mental health disorders and self-care worsening in patients with diabetes through 15 months of COVID-19 pandemic. Subjects and methods Prospective study following patients with type 1 and type 2 diabetes during the COVID-19 pandemic in Southern Brazil. Participants were evaluated through phone calls in two moments: first three months of the outbreak, and 15 months later. The outcomes were the assessment of worsening in mental health disorders (increase ≥ 10% in the total score of the Self-Report Questionnaire), the assessment of emotional distress related to diabetes (increase ≥ 10% in the total score of the Brazilian version of the Problem Areas in Diabetes), and worsening in self-care parameters (reduction ≥ 3 points in the Self-Care Inventory-Revised). Logistic regression models were used to determine the odds ratio (OR) and their respective confidence intervals. Point-biserial correlation coefficients (rpb) were used to measure the relationship between the variation in scores and patient characteristics. Results In total, 150 adults were enrolled (54.6 ± 13.9 years old, 58.7% female, 85.9% white), out of which 118 remained during follow up. After 18 months, 34,7% of them (52.2 ± 14.8 years old, 53.7% female, 87.5% white) worsened mental health scores. An increase in mental health disorders was experienced by patients with lower middle-income [OR 4.2 (1.2-15.0)], and those who reported greater difficulty managing diabetes [OR 3.2 (1.4-7.1); rpb 0.32, P < 0.01]. In contrast, those who perceived an improvement in diabetes control showed a reduction in their mental health scores [OR 0.3 (0.1-0.8)]. For self-care, there was a score worsening in patients with longer duration of diabetes [OR 1.1 (1.0-1.1)] and in those using insulin [OR 8.3 (1.7-41.4); rpb 0.23, P = 0.01]. Conversely, those who followed the social distancing guidance had an improvement in self-care [OR 0.4 (0.1-0.9); rpb 0.18, P = 0.05]. Conclusion Some clinical and socioeconomic characteristics may be suitable for identifying patients at higher risk of mental health and self-care worsening, signaling who needs to be monitored more closely during crisis situations. selfcare self care COVID19 COVID 19 COVID-1 Brazil moments outbreak later 10 SelfReport Self Report Questionnaire, Questionnaire , Questionnaire) Diabetes, Diabetes Diabetes) SelfCare Care InventoryRevised. InventoryRevised Inventory Revised . Inventory-Revised) OR (OR intervals Pointbiserial Point biserial (rpb 54.6 546 54 6 (54. 139 13 9 13. old 587 58 7 58.7 female 859 85 85.9 white, white 11 up 347 34 34,7 52.2 522 52 (52. 148 14 8 14. 537 53 53.7 875 87 5 87.5 middleincome middle income 42 4 4. 1.215.0, 12150 1.2 15.0 0 (1.2-15.0)] 32 3. 1.47.1 1471 1.4 7.1 (1.4-7.1) 032 0.32 0.01. 001 0.01 01 0.01] contrast 03 0. 0.10.8. 0108 0.1 0.8 (0.1-0.8)] selfcare, care, 1. 1.01.1 1011 1.0 (1.0-1.1) 83 8. 1.741.4 17414 1.7 41.4 41 (1.7-41.4) 023 23 0.23 Conversely 04 0.10.9 0109 0.9 (0.1-0.9) 018 0.18 0.05. 005 0.05 05 0.05] situations COVID1 COVID- Inventory-Revised 54. (54 58. 85. 34, 52. (52 53. 87. 215 1.215.0 1215 12 15. (1.2-15.0) 47 1.47. 147 71 7. (1.4-7.1 00 0.0 0.10.8 010 08 (0.1-0.8) 1.01. 101 (1.0-1.1 741 1.741. 1741 17 414 41. (1.7-41.4 02 0.2 0.10. 09 (0.1-0.9 (5 21 1.215. 121 (1.2-15.0 1.47 (1.4-7. (0.1-0.8 1.01 (1.0-1. 74 1.741 174 (1.7-41. 0.10 (0.1-0. ( 1.215 (1.2-15. (1.4-7 (1.0-1 1.74 (1.7-41 (0.1-0 1.21 (1.2-15 (1.4- (1.0- (1.7-4 (0.1- (1.2-1 (1.4 (1.0 (1.7- (0.1 (1.2- (1. (1.7 (0. (1.2 (1 (0