Diabetes Patients Kept Control of Glucose During COVID-19

Despite less clinical care during the COVID-19 pandemic, patients with diabetes held tight on their glucose control, a nationwide study suggested.

In adjusted models, there was a relative 2.6% decline in the proportion of diabetes patients who had at least one outpatient clinical visit — including in-person and telemedicine visits — during the entire pandemic period, as compared with 2019 (85.0% in 2020 vs 87.3% in 2019), reported Ateev Mehrotra, MD, MPH, of Harvard Medical School in Boston, and colleagues.

Following a similar pattern, there was also a drop in routine testing in patients with diabetes, the group wrote in their research letter in JAMA Internal Medicine.

This included a 6.5% drop in HbA1c testing (76.5% vs 81.8%), an 18.8% drop in retinopathy testing (5.6% vs 6.9%), and an 8.5% drop in nephropathy testing (40.1% vs 43.9%).

However, patients didn’t skimp on medication during the pandemic, as fill rates were similar to 2019 — even slightly increasing by 3.6% (64.2% vs 62.2%, respectively).

And despite fewer patients undergoing routine HbA1c testing during the pandemic, those that did showed nearly identical levels to 2019 (7.16% vs 7.14%, respectively).

When looking closer at the trends throughout the pandemic — including the initial 10 weeks prior to the pandemic starting on Jan. 1, 2020 — clinical care was nearly identical to 2019 during the “pre-pandemic” time. But starting in the “early pandemic” period, which encompassed weeks 11 through 29 of 2020, outpatient visits took an unsurprising sharp downturn, as did HbA1c testing, paired with the spike in medication filling.

By the “later pandemic” period, which started at week 30 and continued through Dec. 1, 2020, all measures of clinical care — including outpatient visits, HbA1c testing, HbA1c levels, and filled prescriptions — rebounded to baseline, mirroring that of 2019.

Mehrotra’s group said that the small increase in medication fill rates during the early pandemic period is likely what protected these patients against a loss of glycemic control.

“Mail-order pharmacies and pharmacy delivery services may have been key during the pandemic in ensuring patients received their medications,” they pointed out.

They also noted that this action was “consistent with diabetes disaster preparedness guidelines,” which recommend placing priority on medication access over access to clinician visits during an emergency.

Although the uptick in telemedicine visits wasn’t enough to offset the decrease in overall clinical visits, the researchers said that telemedicine was also key in staving off any major disruptions in medication prescribing.

“Our findings also emphasize that there is not a direct relationship between visit frequency and glycemic control,” they wrote.

For the study, Mehrotra and co-authors drew upon de-identified claims from the OptumLabs Data Warehouse representing adults ages 18 and over with type 2 diabetes who had continuous enrollment in a commercial or Medicare Advantage healthcare insurance plan.

In total, this included 1,357,029 adults in 2019 and 1,364,522 adults in 2020. The two cohorts had similar baseline characteristics, with an average age of 67. About 16% in each cohort used insulin, and 20% were sulfonylurea users. Two-thirds of each cohort were Medicare Advantage beneficiaries, which also may limit the generalizability of the findings. Additionally, 82% of each cohort lived in an urban setting, although the cohorts were fairly evenly split across household incomes.