Speed of recovery of testing for management of diabetes in the aftermath of COVID-19 is slower in areas of greater social deprivation: findings from a UK study

Holland, D.; Heald, A.; Hanna, F.; Wu, P.; Fry, A.

Abstract

Background and aims: We have previously shown that, during the first 6 months of the UK COVID-19-associated lockdown, >6.6M HbA1c tests were missed/delayed, including 1.41M missed/delayed in people with diabetes (0.51M in those with suboptimal control). Studies suggest that COVID-19 has a more significant impact on people with diabetes and those from more deprived backgrounds. We here show data on the variability in speed of recovery of HbA1c testing across 7 UK sites, and its association with demographic characteristics, including deprivation status.

Materials and methods: We examined all HbA1c tests across 570 general practices (GPs; 4.57M population) requested between Jan 2019 and Dec 2021. We compared differences in monthly requests during 4 periods (Apr-Jun 2020 [lockdown 1], Jul-Dec 2020 [inter-lockdown period], Jan-Mar 2021 [lockdown 2] and Apr-Dec 2021 [recovery period]), with their equivalent pre-covid period in 2019. We then examined the effect of practice size, diabetes prevalence, proportion aged over 65 year and deprivation index on these differences for each period.

Results: We showed that, for all 7 centres, monthly requests dropped to 10.6-14.8% of the mean monthly 2019 request numbers in April 2020. During the following 3 periods, degree of recovery to pre-pandemic levels, as well as the drop during lockdown 2, showed greater variability between centres (inter-lockdown period: 74.0-93.2%, lockdown 2: 78.6-94.2%, recovery period: 89.0-105.7%). When examined at a GP practice level, we did not identify any link between age, practice size or diabetes prevalence and post-pandemic recovery. However, we did observe that return to pre-pandemic levels was associated with social deprivation status. Thus, compared with the equivalent pre-pandemic period, levels of HbA1c testing during period 4 (Apr-Dec 2021) were lower in those areas with higher levels of deprivation (91.3-93.5% of 2019 levels for deciles 6-10) than those with lower deprivation (96.2-99.7% of 2019 levels for deciles 1-5) (see figure). Similar findings were also noted during period 2 (inter-lockdown period: Jul-Dec 2020): deprivation deciles 6-10 were 78.2-82.6% of 2019 levels compared with 83.8-88.9% for deciles 1-5. This trend was less evident during lockdown periods 1 and 2.

Conclusion: Our findings reinforce that the COVID-19 pandemic continues to have a major impact on diabetes management, with some centres having yet to return to pre-pandemic levels. This ongoing impact appears most significant in areas of greatest deprivation, thereby adding to the increasing body of evidence showing that those from poorer backgrounds continue to be disproportionately disadvantaged in the context of SARS-CoV-2. There is therefore an onus on healthcare services to implement urgent measures to redress this imbalance.

• Presentation Conference Type: Poster
• Conference Name: 58 th EASD Annual Meeting of the European Association for the Study of Diabetes
• Conference Location: Stockholm, Sweden
• Start Date: Sep 19, 2022
• End Date: Sep 23, 2022
• Deposit Date: Jun 27, 2023
• Publisher URL: https://link.springer.com/article/10.1007/s00125-022-05755-w