‘Making up for lost time’: Managing diabetes disruptions, backlog after COVID-19
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The COVID-19 pandemic had a disproportionately disruptive effect on diabetes care compared with other specialties, with delays in care translating to greater risk for cardiovascular and renal complications that will be difficult to reverse.
U.K. data from the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre show diagnoses for type 2 diabetes among a cohort of 13 million people were down 70% during the pandemic, with more than 45,000 missed or delayed diagnoses, Kamlesh Khunti, MD, PhD, FRCGP, FRCP, FMedSci, professor of primary care diabetes and vascular medicine at the University of Leicester and Leicester General Hospital, United Kingdom, said during a virtual press conference at the European Association for the Study of Diabetes annual meeting.
During the first national lockdown in the U.K. during May 2020, HbA1c tests for monitoring people with type 2 diabetes fell by 77% to 84%, he said. The number of people in England receiving all eight care processes decreased from 58.5% to 19.2% for the complete 2019-2020 year compared with the first three quarters of January through September 2020, Khunti said. Clinicians are now “making up for lost time” to address a backlog of patients needing routine and urgent diabetes care.
“There has been isolation for the vulnerable, social distancing measures, suspension of routine care and redeployment of health care staff. All of this has direct and indirect consequences,” said Khunti, who is also co-director of the Leicester Diabetes Centre. “There has been a decrease in people having care processes measured — eyes checked, feet checked, blood pressure checked. All of this has a huge impact in the backlog of people we now must manage as we go into the recovery phase.”
Impact of delay in care
Even a 1-year impact on risk factor control is dangerous for long-term diabetes outcomes, Khunti said. Data published in Cardiovascular Diabetology in 2015 show a delay in treatment intensification by 1 year, in conjunction with poor glycemic control, significantly increased risk for myocardial infarction by 67%, heart failure by 64%, stroke by 51% and composite CV events by 52% during a median follow-up of 5.4 years.
“Remember that this [pandemic] has also had an impact on people’s mental health as well, and you must make sure people’s mental health is looked after and they are supplied with online self-management education programs also,” Khunti said.
Cases of new-onset diabetes have also increased during the pandemic, likely for several reasons, Khunti said.
“There is stress hyperglycemia, which is seen anytime a new patient is admitted to hospital; people may have preexisting diabetes that was not picked up before,” Khunti said. “People receive steroid therapy in the hospital, and there is an interesting concept of [COVID-19] causing diabetes, but we are not sure of a definite signal, and there is ongoing work in this area.”
Focus on ‘recovery phase’
As clinicians and other providers transition to a pandemic recovery phase, inpatient and outpatient diabetes services that have been disrupted must be restarted, Khunti said, especially those related to urgent care.
“We need to start seeing patients now and prioritize [people with diabetes],” Khunti said. “They need to start having their blood pressure, eyes and feet checked and risk factors managed. Foot services and pregnancy services have done reasonably well during the pandemic, but we really need to start seeing everyone.”
Moving forward, follow-up with patients with new-onset diabetes is something that needs closer scrutiny, as does risk factor control in people with so-called “long COVID,” Khunti said. Most essentially, any person with diabetes, along with their caregivers, must be vaccinated for COVID-19.
“There is data that has come out recently showing that if a patient’s diabetes control is not good, they do not get a good response to the vaccine,” Khunti said. “It is essential that we manage everyone’s diabetes and risk factor control well.”
Reference:
Paul SK, et al. Cardiovasc Diabetol. 2015;doi:10.1186/s12933-015-0260-x.
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Khunti K. Care of people with diabetes post-COVID-19 in primary care. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 27-Oct. 1, 2021 (virtual meeting).
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