Effects of COVID-19 on Dutch diabetes care

Abstract Aims The COVID-19 pandemic impacted diabetes care by reducing diabetes outpatient visits and diabetes-related screening due to healthcare allocation. Yet the impact of COVID-19 on diabetes outpatients has not been extensively evaluated. This study aimed to assess the effect of the COVID-19 pandemic on all aspects of outpatient diabetes care, particularly diagnostics and intermediate outcomes. Methods This observational cohort study included 8,442 diabetes patients in the Dutch Pediatric and Adult Registry of Diabetes (DPARD) visiting diabetes outpatient clinics in 2019 and 2021. A mixed-effects regression analysis was used to examine differences in target achievement of HbA1c, BMI, blood pressure, LDL-cholesterol, eGFR, and the difference in mean HbA1c between 2019 and 2020 among n=1,426 outpatients who visited in both years. Analyses were adjusted for age, sex, and BMI Results A 22.7% (21.6 - 23.8%, p<0,001) decline in outpatient volume was observed during the pandemic. BMI, lipid spectrum, kidney function, and HbA1c were assessed less frequently in 2020 than in 2019. In 2020, compared to 2019, the median HbA1c level increased by 2.2% (1.0 mmol/mol, p=0.035) and the percentages of patients with known HbA1C meeting targets below 10, 8, 7% (86, 64, and 53 mmol/mol) decreased by 0.5%, 1.7% and 1.4%, respectively. Target blood pressure ≤130/80 mmHg was achieved more often in 2020 (15.0% versus 18.3%, p= 0.018), while HbA1c ≤86 mmol/mol was achieved less (89.3% versus 87.1%, p=0.001), among n=1,426 diabetes outpatients seen in both 2019 and 2020. In patients visiting both years, HbA1c was 2.3% (1.9 mmol/l, 95% CI 1.2-2.5, p<0.001) lower during the pandemic than in the prepandemic. Conclusions The COVID pandemic impacted Dutch diabetes outpatient care by reducing patient volume by 22.7%. Among patients who received outpatient care both before and during the pandemic period, HbA1c control and blood pressure control enhanced during the pandemic. Re-evaluation of current diabetes outpatient care organization is warranted to ensure optimal diabetes care in future times.