Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing: implications for diabetes management and diagnosis

Abstract

AimsThe COVID-19 pandemic, and the focus on mitigating its effects, has disrupted diabetes healthcare services worldwide. We aimed to quantify the effect of the pandemic on diabetes diagnosis/management, using glycated haemoglobin (HbA1c) as surrogate, across six UK centres.MethodsUsing routinely collected laboratory data, we estimated the number of missed HbA1c tests for ‘diagnostic’/‘screening’/‘management’ purposes during the COVID-19 impact period (CIP; 23 March 2020 to 30 September 2020). We examined potential impact in terms of: (1) diabetes control in people with diabetes and (2) detection of new diabetes and prediabetes cases.ResultsIn April 2020, HbA1c test numbers fell by ~80%. Overall, across six centres, 369 871 tests were missed during the 6.28 months of the CIP, equivalent to >6.6 million tests nationwide. We identified 79 131 missed ‘monitoring’ tests in people with diabetes. In those 28 564 people with suboptimal control, this delayed monitoring was associated with a 2–3 mmol/mol HbA1c increase. Overall, 149 455 ‘screening’ and 141 285 ‘diagnostic’ tests were also missed. Across the UK, our findings equate to 1.41 million missed/delayed diabetes monitoring tests (including 0.51 million in people with suboptimal control), 2.67 million screening tests in high-risk groups (0.48 million within the prediabetes range) and 2.52 million tests for diagnosis (0.21 million in the pre-diabetes range; ~70 000 in the diabetes range).ConclusionsOur findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for, diabetes. For people with diabetes, missed tests will result in further deterioration in diabetes control, especially in those whose HbA1c levels are already high.

The Effect of the COVID-19 Pandemic on Glycemic Monitoring and Other Processes of Care for Type 2 Diabetes: Protocol for a Retrospective Cohort Study

“…Remote monitoring systems proved to be feasible and were supported by the current clinical guidelines [ 3 ]. However, the study results might represent a considerable burden of unmet need, validating the results of other studies [ 2 , 8 ].…”

“…Previous studies have identified that missed hemoglobin A 1c (HbA 1c ) monitoring appointments is associated with higher HbA 1c [ 6 , 7 ]. A recent study showed a 40% reduction in HbA 1c testing during the first year of the COVID-19 pandemic compared to the preceding year [ 8 ]. It is well established that impaired glycemic control is associated with the increased risk of micro- and macrovascular complications [ 8 , 9 ], indicating the benefit to people with T2DM having regular HbA 1c monitoring.…”

Variability in Test Interval Is Linked to Glycated Haemoglobin (HbA1c) Trajectory over Time

“…The results of this study are particularly pertinent as we come to appreciate the consequences of the COVID-19 pandemic on the way that routine care for people with diabetes is delivered. In this regard, we recently reported a fall in volume of HbA1c tests following the first UK lockdown in March 2020 [ 33 ]. Specifically, by September 2020, there were as many as 1.41 million missed/delayed diabetes monitoring tests, including an estimated 0.51 million in people with suboptimal blood glucose control.…”

Living with diabetes and its impact on mental health: results of an online survey

“…We suggest that these factors be considered when planning psychosocial interventions and behavior change messaging to support people with diabetes, in relation to the multiple challenges that they face, particularly given the impact of the COVID-19 pandemic on routine care for people with diabetes in the UK and elsewhere [ 4 ].…”

“…We conducted an online survey of people with diabetes, who had agreed to be involved through the research for the future (RfTF) project, in relation to their lived experience of the condition [4]. PHQ-9 (depression) [5], Diabetes Distress Screening Scale (DDSS) [6] and EQ5D5L QOL [7] questionnaires were completed by 130 people with diabetes and their clinical records were also examined.…”