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The Effect of the COVID-19 Pandemic on HbA1c Testing: Prioritization of High-Risk Cases and Impact of Social Deprivation.

Authors :
Holland, David
Heald, Adrian H.
Hanna, Fahmy F. W.
Stedman, Mike
Wu, Pensée
Sim, Julius
Duff, Christopher J.
Duce, Helen
Green, Lewis
Scargill, Jonathan
Howe, Jonathon D.
Robinson, Sarah
Halsall, Ian
Gaskell, Neil
Davison, Andrew
Simms, Mark
Denny, Angela
Langan, Martin
Fryer, Anthony A.
Source :
Diabetes Therapy. Apr2023, Vol. 14 Issue 4, p691-707. 17p.
Publication Year :
2023

Abstract

Introduction: Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control and demographic characteristics. Methods: In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics. Results: In April 2020, monthly requests dropped to 7.9–18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7–86.9% of 2019 levels. During April–June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4–63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April–June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April–June 2020; trend test p < 0.001) and two subsequent periods (July–September and October–December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group. Conclusion: Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59–86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
18696953
Volume :
14
Issue :
4
Database :
Academic Search Index
Journal :
Diabetes Therapy
Publication Type :
Academic Journal
Accession number :
162852063
Full Text :
https://doi.org/10.1007/s13300-023-01380-x