A new study, published this week in the scientific journal, The Lancet has found that there would have been 3075 fewer deaths among people with diabetes in the UK were it not for the effect of the Covid-19 lockdown which reduced access to care processes.
The research found that the number of deaths were significantly elevated in 2021 compared with pre pandemic levels in 2019, even after accounting for age, sex, ethnicity, deprivation, and diabetes type.
The disruption of routine diabetes care during the Covid lockdown meant that far fewer people with diabetes were attending all eight of the care processes needed for routine care and management of the condition.
Prior to the Covid crisis, some 48.1% of people with diabetes received all eight care processes required which are: measurement of glycated hemoglobin, blood pressure, cholesterol, serum creatinine, urine albumin, and BMI measurement, in addition to foot surveillance and assessment of smoking status.
However, the researchers found that during the pandemic period that number almost halved – falling to just 26.5% of people with diabetes presenting for the full set of processes they needed.
The largest decreases in attendance for care processes was seen among the most deprived people and among those of White versus non-White ethnicity, the research found.
“Our results provide evidence that the increased rate of non-COVID-19-related mortality in people with diabetes in England observed between July 3, and Oct 15 of 2021 is associated with a reduction in completion of routine diabetes care processes following the pandemic onset in 2020,” the authors wrote.
“Our data, combined with data from other studies, suggests that the pandemic has been associated with a double mortality hit for people with diabetes.”
In a comment piece on the findings, David Hopkins and Francesco Rubino, both from King’s College London in the UK, said the findings were “a stark reminder that diabetes remains a serious and potentially deadly disease.”
They note: “Even before the pandemic, there were difference[s] in mortality among people with diabetes according to completeness of the care processes; an effect that has been amplified by the disruption to routine care that has occurred since March, 2020.”
And they warned that further studies might reveal that the negative outcomes related to treatment disruptions might continue.
“Furthermore, given the time course for progression of diabetes complications, the effect of the disruption of care due to the pandemic on diabetes outcomes will probably persist for some years. Therefore ongoing prospective evaluation of rates of diabetic microvascular and macrovascular complications and mortality in the coming years will be desirable to determine the true effect of the pandemic and the related disruption to care.”
They also called for an appropriate response to ensure restoration of diabetes care received the attention it required.
“The effect in mortality according to completeness of the care processes could remain an issue in pandemic times and beyond if not dealt with appropriately. There is a risk that restoration of both routine (mostly provided in a primary care setting) and specialist diabetes care might receive less attention than present major areas of focus of recovery planning: restoring elective surgery and diagnostic procedures, particularly around cancer pathways.”
“A 2021 survey of 1070 UK primary care health-care professionals, with a 91% response rate, found that 79% considered their provision of routine diabetes services had been impacted by the pandemic,” they wrote.
The data for the study came from the UK National Diabetes Audit and encompassed 3,218,570 people – of whom 7.6% had type 1 diabetes, 90.9% had type 2 diabetes, and 1.5% had other types.