A retrospective analysis found there were disparities in the continuation of care among some patients with diabetes during the first 6 months of the ongoing COVID-19 pandemic. These findings were published in Diabetes Care.

Patients with diabetes (N=4523) who were cared for by the University of California Davis Health (UCDH) and University of California San Francisco (UCSF) were assessed for care trends in the 6 months prior to the COVID-19 pandemic (September 19, 2019-March 18, 2020) and during the first 6 months of what is traditionally accepted as the first 6 months of the pandemic (March 19, 2020-September 18, 2020). Patients with diabetes included those with either type 1 (T1D) or type 2 (T2D); 2074 people with T1D and 2449 with T2D.

Prior to the pandemic, both UCDH and UCSF had existing telehealth infrastructure. The rate of telehealth use at UCDH increased from  <1% of diabetes visits in February 2020 to 90% by April 2020, and UCSF telehealth visits increased from 8% to >99%, respectively,  due in part to COVID-19 office visit restrictions.


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Overall, during the first 6 month of the pandemic, 23.4% of established patients did not continue receiving subspecialty diabetes care. Patients who were able to continue onsite care at UCDH were more likely to continue receiving care than patients at UCSF (adjusted incidence rate ratio [aIRR], 1.07; 95% CI, 1.03-1.12; P =.002).

Fewer patients with T2D  continued receiving care (aIRR, 0.90; 95% CI, 0.86-0.94; P <.001) compared with T1D.

Compared with children, adolescents, and young adults (persons aged 1 to 24 years of age), fewer patients aged 25-49 years (aIRR, 0.88; 95% CI, 0.83-0.93; P <.001) and 50-65 years (aIRR, 0.93; 95% CI, 0.88-0.98; P =.011) continued receiving care at levels prior to the pandemic.

This study was limited by a lack of data about glycemic control, as 73.7% of patients had no information about glycated hemoglobin (HBA1C) available. In addition, patients with missing data were less likely to continue receiving care (aIRR, 0.93; 95% CI, 0.87-0.98; P =.011).

“Our findings highlight the impact of health system and local factors, including site of care, local policies, and decisions about care delivery, on the receipt of care by people with diabetes. This analysis should motivate other centers to examine any pandemic-associated lapses in care within their served populations of people with diabetes and to qualitatively evaluate the reasons for these,” the authors concluded. “As our field works to develop postpandemic diabetes care models that involve a hybrid of telehealth and in-person visits, we must design these models with attention to how care modality options may impact ongoing participation in care for various populations of people with diabetes.”

Disclosure: Some authors declared affiliations with pharmaceutical and other private industries.  Please see the original reference for a full list of authors’ disclosures.

Reference

Haynes SC, Kompala T, Tancredi DJ, Neinstein AB, Crossen SS. Factors associated with discontinuation of subspecialty diabetes care during the COVID-19 pandemic: a multisite retrospective cohort study. Diabetes Care. 2022;45(2):e34-e36. doi:10.2337/dc21-1360