Disruption to routine diabetes care processes during the pandemic: evidence from a large integrated health system in the Southeast United States
Authors' conclusion
In an integrated healthcare system, the proportion of people with diabetes meeting guideline-recommended screenings decreased during the pandemic, coinciding with worsening glucose, kidney, and (some) cardiovascular risk profiles. Follow-up is needed to assess the long-term implications of these care gaps.
Study context
- Population
- Adults (≥18 years) with prevalent diabetes as of 1 January 2018, continuously enrolled at Kaiser Permanente Georgia through 31 December 2021
- Participants
- 22,854 adults
- Exposure
- During COVID vs pre-COVID
- Outcome
- Annual adherence to seven diabetes care guidelines (at least one measurement per year per period)
Methodological detailswithin-subject pre/during COVID comparison, logistic and linear generalized estimating equations (GEE) adjusted for baseline age, electronic medical record data, integrated health system
- Within-subject pre/during COVID comparison
- Logistic and linear GEE adjusted for baseline age
- Electronic medical record data
- Integrated health system
Main finding
As reported in the abstract
Decreased significantly during vs pre COVID; range in absolute reductions
−0.8% to −11.2%
Absolute reduction, blood pressure (BP)
−11.2%
Absolute reduction, cholesterol
−8.8%
Observational data: associations, not effects.
Further findings
Guideline adherence declines by age, sex and race subgroups · during vs pre-COVID
- Declines were similar across age, sex and race subgroups
Mean laboratory measurements · during vs pre-COVID
- Average HbA1c increase
- 0.11%
- Systolic BP increase
- 1.6 mmHg
- LDL-C decline
- 8.9 mg/dL
Proportion at high risk of kidney disease (urine-albumin-creatinine ratio (UACR) ≥300 mg/g)
- Proportion of adults at high risk of kidney disease increased
- from 6.5% to 9.4%
Original publication
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