Impact of COVID-19 pandemic on HbA_1c management and results in pediatric and adult outpatients with diabetes

Abstract

Objectives Diabetes mellitus intensify the risks and complications related to COVID-19 infection. A major effect of the pandemic has been a drastic reduction of in-person visits. The aim of this study was to evaluate the impact of the COVID-19 pandemic on HbA1c management and results among pediatric and adult outpatients with diabetes, considering the laboratory and point-of-care testing (POCT) HbA1c measurements. Methods Observational retrospective study including patients from pediatric and adult diabetes units was conducted. HbA1c results obtained in the laboratory and POCT over 3 years (2019–2021) were collected from the laboratory information system. Results After the lockdown, the number of HbA1c plummeted. Children returned soon to routine clinical practice. The number of HbA1c increased gradually in adults, especially in POCT. Globally, HbA1c results were lower in children compared with adults (p<0.001). HbA1c values in children (p<0.001) and adults (p=0.002) decreased between pre-pandemic and post-pandemic periods, though lower than the HbA1c reference change value. The percentage of HbA1c results above 8% remained stable during the study period. Conclusions Continuous glucose monitoring and a telemedicine have been crucial, even allowing for improvements in HbA1c results. During the lockdown, patients with better metabolic control were managed in the laboratory whereas patients with poorer control or a severe clinical situation were attended in diabetes units by POCT. Adults returned to pre-pandemic management slowly because they were more susceptible to morbidity and mortality due to COVID-19. Coordination among all health professionals has been essential to offering the best management, especially in difficult scenarios such as the COVID-19 pandemic.

Effect of COVID-19 lockdown on glycated haemoglobin testing and utilisation in KwaZulu-Natal, South Africa

“… 33 , 34 Remarkably, a study conducted in Spain in 2021 instead reported improved glycaemic control during the pandemic, and this was supported by two systematic reviews and meta-analyses performed in the United Kingdom and Germany in 2021. 35 , 36 , 37 In contrast to the findings of these studies, we found a significant increase in the average HbA1c result during the pandemic of 2.2 mmol/mol (0.2%) overall and in nine of the districts, indicating poorer glycaemic control during the pandemic where decreased numbers of HbA1c tests were being conducted. Notably, the Harry Gwala district, which had an increase of 31.8% in HbA1c tests performed during the pandemic, also demonstrated a significantly improved pandemic average HbA1c result.…”

Impact effects of COVID‐19 pandemic on chronic disease patients: A longitudinal prospective study

“…Several studies found a decline in glycaemic control where up to 48.88% had poorly controlled diabetes (Biamonte et al., 2021; Robinson et al., 2020; Varma et al., 2021). However, not all studies have shown a worsening of glycaemic control in relation to the COVID‐19 lockdown; for example, studies carried out in Spain (Enguix et al., 2022; Oliver et al., 2023; Palanca et al., 2022) and other different European countries did not find a significant impairment (Bonora et al., 2020; Carr et al., 2021; Kofoed & Timm, 2022; Kowall et al., 2021; Ludwig et al., 2021). This fact could be explained by the increase in insulin prescription rates (Carr et al., 2022).…”

“…Other studies have focused on the effect of the pandemic on the control of patients with diabetes mellitus, finding inconsistent results (Abed Alah et al., 2021; Carr et al., 2022; Kaddar et al., 2022; Kofoed & Timm, 2022; O'Mahoney et al., 2022). In Spain, some studies carried out only in diabetic patients found no significant changes during the lockdown and post‐lockdown (Oliver et al., 2023; Palanca et al., 2022). However, to date, there are few studies that have evaluated the follow‐up over time of clinical parameters in chronic patients (Dehghani Tafti et al., 2023; Fikree et al., 2023), and none have jointly analysed the most common chronic diseases as well as the short‐ and medium‐term effects.…”

The profound impact of COVID-19 on the control and care of diabetic patients: a comprehensive retrospective cohort study

“…Lower acute physical activity adversely affected glycaemic control through a reduction in insulin sensitivity and lipid pro les, increased in ammation, and reduced muscle protein synthesis (Martinez-Ferran et al, 2020; Oliver et al, 2023) (13,14) COVID-19 alters the lipid pro le with lower TC, TG, LDL and HDL-C, which eventually regulates the cytokine and immune response. These lower pro les are associated with the severity and mortality of the cases (Chidambaram et al, 2022) ((15).…”