Background: The COVID-19 pandemic has had a profound effect on healthcare systems around the world, including the delay or cancellation of important appointments and procedures for managing type 2 diabetes (T2D). It is believed that general practitioners (GPs) saw fewer patients during the pandemic's first wave.
Objectives: We aimed to investigate the impact of the pandemic on primary healthcare utilization and clinical outcomes for individuals with T2D. Additionally, we aimed to determine if changes were observed among specific groups: (1) persons who met their HbA1c targets, and those who did not; (2) persons above and below 70 years of age; and (3) persons with high-risk or low-risk T2D.
Methods: This retrospective study used data from the DIAbetes MANagement and Treatment (DIAMANT) cohort, derived from the electronic medical records of Dutch general practitioners. The study assessed GP visit counts, and values and counts of clinical measurements, comparing 2019 and 2020. Descriptive analyses were performed to examine the characteristics and clinical measurements of people with T2D, such as hemoglobin A1c (HbA1c), body mass index (BMI), low-density lipoprotein (LDL), and blood pressure. Generalized estimating equations (GEE) and Poisson models were utilized to estimate the population averages of clinical measurements and GP visit counts, respectively, comparing 2019 and 2020. Sensitivity analyses were conducted for both GEE and Poisson models, comparing only the lockdown period in 2020 to the same period in 2019 (March 1 to June 30).
Results: The cohort consisted of 182,048 patients with T2D (47% women, mean age 69 years ± 13 years) on March 1, 2019. Initial results indicated a decrease in the number of clinical measurements in 2020, including blood pressure (-31%), BMI (-28%), HbA1c (-17%), LDL (-9%), and eGFR (-8%). The number of GP contacts increased in 2020 for phone calls (+29%) and office visits (+7%), but decreased for home visits (-7%). On a population level, HbA1c increased in 2020 by 1.6 mmol/mol compared to 2019. Observed changes in 2020 for BMI, LDL, and blood pressure were statistically significant but not clinically relevant. Worse clinical outcomes were found in persons < 70 years, persons who met their HbA1c target, and low-risk T2D patients.
Conclusions: During the first year of the COVID-19 pandemic in the Netherlands, changes in primary healthcare use were observed among individuals with T2D, with an increase in GP office visits and phone calls, and a decrease in clinical measurements and GP home visits. HbA1c levels increased among patients with T2D in 2020. Further research is necessary to assess the impact of decreased healthcare use on clinical outcomes and complications, and if the observed increase in HbA1c levels is linked to long-term T2D complications.
