MidwireResearch suggests that disrupting routine diabetes care during a pandemic may have increased the risk of death from causes unrelated to COVID-19.
In a comment related to the publication in Lancet Diabetes and EndocrinologyDavid Hopkins and Francesco Rubino, both from King’s College London in the UK, say the findings are “a stark reminder that diabetes remains a serious and deadly disease.”
They noted: “Even before the pandemic, there was a difference[s] in diabetes mortality by completeness of care processes; An effect that has been amplified by the disruption to routine care that has occurred since March 2020.”
The study authors, led by Jonathan Vallabjee (NHS England and Improvement, London, UK), found that even in the pre-pandemic period (2019-2020), only 48.1% of people received all eight of the care under study, and this is a measurement of glycated hemoglobin . blood pressure, cholesterol, serum creatinine, urine albumin, body mass index, as well as receiving foot monitoring and assessment of smoking status.
But in the pandemic period (2020-2021) this fell to just 26.5%, according to the team’s report, with the largest decrease recorded among the most disadvantaged and among those of the white versus non-white race. Foot surveillance recorded the largest relative decrease between the pre-pandemic and pandemic periods, at 37.5%, and the smallest measure of serum creatinine at 12.1%.
Data for the study came from the UK National Diabetes Review and included 318,570 people with complete data on care processes, of whom 7.6% had type 1 diabetes, 90.9% had type 2 diabetes, and 1.5% had other types.
Comparing two 15-week periods between July and October — one in 2019 and one in 2021 — the researchers found an 11% increase in mortality from causes other than COVID-19, with unadjusted rates per 100,000 people with diabetes of 912 and 936 in 2019 and 2021 respectively.
The mortality rate was significantly higher at 1,023 in 2021 compared to 2019 after accounting for age, gender, race, deprivation and type of diabetes.
Vallabji and his team found a “clear dose-response relationship” between receiving care and mortality and risk, both before a pandemic and during a pandemic. People who received all eight caregivers in each of the previous two years had the lowest non-COVID-19 mortality rate and those who did not in either had the highest, with average rates observed in people who received all of them in one year but not the other.
In 2021, people who did not receive all eight caregivers in any of the past two years were 2.67 times more likely to die than those who received them in both years, after accounting for confounders.
The study authors say that had there not been an epidemic-related decline in diabetes care intake, there would have been 3,075 fewer deaths among people with the condition. The expected death rate per 100,000 people with diabetes was 840, but the observed rate was 936.
In their commentary, Hopkins and Rubino note that the researchers were unable to assess the impact of epidemiological disturbances on nonfatal outcomes “such as hospitalization or the development of diabetes complications,” and called for further studies to address this.
“Furthermore, given the time course for developing complications of diabetes, it is likely that the impact of care interruptions due to the epidemic on diabetes outcomes will persist for some years.”
Finally, commentators highlight “the risk that restoring both routine (mostly provided in a primary care setting) and specialized diabetes care has received less attention than the current main areas of focus for recovery planning: restoring elective surgery and diagnostic procedures, particularly regarding cancer pathways.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group
Lancet Diabetes and Endocrinology 2022; doi: 10.1016/S2213-8587 (22) 00131-0
Lancet Diabetes and Endocrinology 2022; doi: 10.1016/S2213-8587 (22) 00162-0