Disruption Caused by the COVID-19 Pandemic on HbA1c Testing and Its Implications for Diabetes (DM) Management/Diagnosis

We explored the impact of the COVID-19 pandemic on DM management/diagnosis. We extracted routine HbA1c data from laboratory systems at 5 UK hospitals from October2017-September2020 (representing 3.3million people; ~4.8% of the UK population). From these data(3million tests), we calculated monthly missed monitoring/diagnostic tests from 23 March-30September 2020. We found that HbA1c tests dropped by 82-88% in April and had not reached expected volumes by September(Figure 1). During the 6-month period, in people with DM/at risk of DM, 206,422 monitoring tests were missed. Of these, 23,466 (11.4%) had previous HbA1c values ≥59mmol/mol. The testing delay in this group would, on average, result in a mean increase in HbA1c of 5.7 mmol/mol above that expected if monitoring was according to NICE guidance. There were also an estimated 81,245 missed diagnostic tests. Of these, ~6,105(7.5%) would be expected to be in the pre-DM range(42-47 mmol/mol) and ~3,633(4.5%) within DM range (≥48 mmol/mol), with ~1,333 of these having HbA1c values of ≥76 mmol/mol. Extrapolating to the UK population, this equates to missed monitoring tests in 489,000 people with sub-optimally-controlled DM, ~127,000 missed pre-DM and 76,000 missed DM diagnoses. Our findings illustrate the widespread collateral impact of implementing measures to mitigate COVID-19 impact in people with, or being investigated for DM.View largeDownload slideView largeDownload slide DisclosureD. Holland: Other Relationship; Self; Siemens Corporation. A. H. Heald: None. M. Stedman: None. L. A. Green: None. J. Scargill: None. C. Duff: None. F. Hanna: None. P. Wu: None. A. A. Fryer: None.