National Changes in Diabetes Care Practices during the COVID-19 Pandemic: Prospective Study of US Adults

Changes in diabetes screening and exercise during the COVID-19 pandemic in adults with prediabetes

AIMS

To evaluate changes in type 2 diabetes mellitus (T2DM) screening and exercise during the COVID-19 shelter-in-place, and whether Medicaid patients and racial/ethnic minoritized groups were disproportionally affected.

METHODS

Retrospective cohort study of 578,585 adults with prediabetes aged ≥ 18-89 years with BMI ≥ 25 (≥23 if Asian) at Kaiser Permanente Northern California from January 2019 to December 2021. We used separate interrupted time-series analyses of aggregated weekly T2DM screening rates, or mean exercise minutes, to evaluate any decrease associated with the shelter-in-place (March 19, 2020, to June 1, 2020). Analyses were performed in 2023-2024.

RESULTS

Before Covid, 121/10,000 patients/week were screened for T2DM, and patients exercised 107 min/week. Initially, screening dropped to near zero (by ∼ 96 %) followed by a slow increase of 7.4 (95 % CI: 2.4-12.4, p-value 0.004)/10,000 patients/week during the shelter-in-place. Similarly, exercise decreased initially by 37 (29-45, p-value < 0.001) minutes/week, followed by a slow increase of 3.5 (1.7-5.4, p-value < 0.001) minutes/week during the shelter-in-place. These patterns were similar across racial/ethnic groups; however, Medicaid patients took 1.5 years to resume baseline exercise levels.

CONCLUSIONS

The shelter-in-place was associated with an abrupt decrease in T2DM screening and exercise among adults with prediabetes. Future mandates should support high-risk populations, especially Medicaid, to maintain T2DM screening and exercise to prevent T2DM progression.

Changes in diabetes care and management practices during the COVID-19 pandemic

BACKGROUND

We examined changes in diabetes care and management practices before and during the COVID-19 pandemic.

METHODS

Population-based data regarding four diabetes-related healthcare engagement and four self-management indicators were obtained from adults with diabetes surveyed in 19 US States and Washington DC through the Behavioral Risk Factor Surveillance System. Using logistic regression, we estimated changes in the prevalence of each indicator, overall and by sociodemographic subgroups in 2019 (before the pandemic) and 2021 (during the pandemic).

RESULTS

Between 2019 and 2021, the prevalence of biannual HbA1c tests reduced by 2.6 percentage points (pp; 95% confidence interval: -4.8, -0.4), from 75.4% to 73.1%, and prevalence of annual eye exams fell by 4.0 pp (-6.2, -2.8), from 72.2% to 68.7%. The composite indicator of engagement with healthcare for diabetes control fell by 3.5 pp (-5.9, -1.1), from 44.9% to 41.9%. Of self-management behaviors, avoidance of smoking increased by 2.0 pp (0.4, 3.6) from 84.7% to 87.1%.

CONCLUSIONS

The findings suggest a deterioration of the uptake of evidence-based, preventive health services requiring laboratory services and clinical examination for diabetes control during the pandemic. On the other hand, smoking rates decreased, suggesting potential positive impacts of the pandemic on health behaviors in people with diabetes.

Changes in Diabetes Care and Management Practices during the COVID-19 Pandemic

Background

Evidence suggests diabetes management was negatively impacted early in the pandemic. However, the impact of the pandemic on key healthcare services for diabetes control and diabetes self-management practices is less known. We examined changes in diabetes care and management practices before and during the COVID-19 pandemic.

Methods

Population-based data regarding 4 diabetes-related healthcare engagement and 4 self-management indicators were obtained from adults with diabetes surveyed in 19 US States and Washington DC through the Behavioral Risk Factor Surveillance System. Using logistic regression, we estimated changes in the prevalence of each indicator, overall and by sociodemographic subgroups, before (2019; n = 15,307) and during (2021; n = 13,994) the COVID-19 pandemic.

Results

Between 2019 and 2021, the prevalence of biannual HbA1c tests reduced by 2.6 percentage points (pp, 95% CI :-4.8, -0.4), from 75.4-73.1%, and prevalence of annual eye exams fell by 4.0 pp (-6.2, -2.8), from 72.2-68.7%. The composite indicator of engagement with healthcare for diabetes control fell by 3.5 pp (-5.9, -1.1), from 44.9-41.9%. Reductions in engagement with healthcare were largely seen across sex, age, education, employment status, marital status, insurance status, and urbanicity; and were more pronounced among those aged 18-34 and the uninsured. Reductions in engagement with healthcare were seen in several states, with Delaware and Washington DC reporting the largest decrease. Of self-management behaviors, we only observed change in avoidance of smoking, an increase of 2.0 pp (0.4, 3.6) from 84.7-87.1%.

Conclusions

The pandemic had mixed impacts on diabetes care and self-management. The findings suggest a deterioration of the uptake of evidence-based, preventive health services requiring laboratory services and clinical examination for diabetes control during the pandemic. On the other hand, smoking rates decreased, suggesting potential positive impacts of the pandemic on health behaviors in people with diabetes.