The Effect of the COVID-19 Pandemic on HbA1c Testing: Prioritization of High-Risk Cases and Impact of Social Deprivation
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.
Adrian H. Heald
Fahmy F.W. Hanna
Pensee Wu email@example.com
Julius Sim firstname.lastname@example.org
Christopher J. Duff
Jonathon D. Howe
Professor Anthony Fryer email@example.com
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.
|Journal Article Type||Article|
|Acceptance Date||Feb 7, 2023|
|Online Publication Date||Feb 22, 2023|
|Publicly Available Date||May 30, 2023|
|Peer Reviewed||Peer Reviewed|
|Keywords||Glycated haemoglobin; HbA1c; Diabetes mellitus; Monitoring; Index of multiple deprivation; Pandemic; COVID-19; Recovery|
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