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O'Mahoney LL, Highton PJ, Kudlek L, Morgan J, Lynch R, Schofield E, Sreejith N, Kapur A, Otunla A, Kerneis S, James O, Rees K, Curtis F, Khunti K, Hartmann‐Boyce J. The impact of the COVID-19 pandemic on glycaemic control in people with diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2022; 24:1850-1860. [PMID: 35603919 PMCID: PMC9347483 DOI: 10.1111/dom.14771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022]
Abstract
AIM To identify, appraise and synthesize the available evidence on the impact of the coronavirus disease 2019 (COVID-19) pandemic and lockdown (LD) on glycaemic control in people with diabetes. MATERIALS AND METHODS We searched multiple databases up to 2 February 2021 for studies reporting HbA1c, time in range (TIR), average or fasting glucose, severe hypoglycaemia and diabetic ketoacidosis. Data were pooled using random effects meta-analysis and are presented as mean difference (MD) with 95% confidence intervals (CI). This review was preregistered on PROSPERO (CRD42020179319). RESULTS We include 59 studies; 44 (n = 15 464) were included in quantitative syntheses and 15 were narratively synthesized. Pooled data were grouped by diabetes type. Results from 28 studies (n = 5048 type 1 diabetes [T1D] and combined diabetes participants) showed that TIR increased during LD compared with before LD (MD 2.74%, 95% CI 1.80% to 3.69%). Data from 10 studies (n = 1294 T1D participants) showed that TIR increased after LD compared with before LD (MD 5.14%, 95% CI 3.12% to 7.16%). Pooled results from 12 studies (n = 4810 T1D and type 2 diabetes participants) resulted in average glucose decreasing after LD compared with before LD (MD -6.86 mg/dl, 95% CI -8.54 to -5.18). Results for other outcomes, including HbA1c, were not statistically significantly different. CONCLUSIONS The COVID-19 pandemic was associated with small improvements across multiple outcomes of glycaemic control, although there was insufficient evidence to suggest that this led to changes in HbA1c. Most evidence came from people with access to diabetes technologies in high-income countries; more research is needed in less advantaged populations.
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Affiliation(s)
| | | | - Laura Kudlek
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Rosie Lynch
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | | | | | - Ajay Kapur
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | | | - Sven Kerneis
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | - Olivia James
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | - Karen Rees
- Freelance Systematic ReviewerWarwickshireUK
| | - Ffion Curtis
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
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Townsend R, Chmielewska B, Barratt I, Kalafat E, van der Meulen J, Gurol-Urganci I, O'Brien P, Morris E, Draycott T, Thangaratinam S, Doare KL, Ladhani S, Dadelszen PV, Magee LA, Khalil A. Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis. EClinicalMedicine 2021; 37:100947. [PMID: 34195576 PMCID: PMC8233134 DOI: 10.1016/j.eclinm.2021.100947] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic. METHODS We performed a systematic review and meta-analysis of studies of the effects of the pandemic on provision of, access to and attendance at maternity services (CRD42020211753). We searched MEDLINE and Embase in accordance with PRISMA guidelines from January 1st, 2020 to April 17th 2021 for controlled observational studies and research letters reporting primary data comparing maternity healthcare-seeking and healthcare delivery during compared to before the COVID-19 pandemic. Case reports and series, systematic literature reviews, and pre-print studies were excluded. Meta-analysis was performed on comparable outcomes that were reported in two or more studies. Data were combined using random-effects meta-analysis, using risk ratios (RR) or incidence rate ratios (IRR) with 95% confidence intervals (CI). FINDINGS Of 4743 citations identified, 56 were included in the systematic review, and 21 in the meta-analysis. We identified a significant decrease in the number of antenatal clinic visits (IRR 0614, 95% CI 0486-0776, P<00001, I2=54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602-0911, P = 00046, I2=00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762-2794, P<00001, I2=90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118-1319, P<00001, I2=00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407-0690, P<00001, I2=00%). There was no significant change in intrapartum epidural use (P = 00896) or the use of GA for elective CS (P = 079). INTERPRETATION Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.
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Affiliation(s)
- Rosemary Townsend
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
| | - Barbara Chmielewska
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Imogen Barratt
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Erkan Kalafat
- Middle East Technical University, Faculty of Arts and Sciences, Department of Statistics, Ankara, Turkey
- Koc University, School of Medicine, Department of Obstetrics and Gynaecology, Istanbul, Turkey
| | - Jan van der Meulen
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Ipek Gurol-Urganci
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Pat O'Brien
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Edward Morris
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Tim Draycott
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- North Bristol NHS Trust Department of Women's Health, Westbury on Trym, United Kingdom
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
- Immunisation and Countermeasures Division, Public Health England, United Kingdom
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
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