Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing: implications for diabetes management and diagnosis

• DOI: 10.1136/jclinpath-2021-207776
• Publication Date: 2021-10-13T19:33:02Z
• Authors: David Holland; Adrian H Heald; Mike Stedman; Fahmy Hanna; Pensee Wu; Christopher Duff; Lewis Green; Sarah Robinson; Ian Halsall; Neil Gaskell; John Pemberton; Christine Bloor; Anthony A Fryer
• Keywords: Pandemic; 2019-20 coronavirus outbreak

Aims The COVID-19 pandemic, and the focus on mitigating its effects, has disrupted diabetes healthcare services worldwide. We aimed to quantify effect of pandemic diagnosis/management, using glycated haemoglobin (HbA1c) as surrogate, across six UK centres. Methods Using routinely collected laboratory data, we estimated number missed HbA1c tests for ‘diagnostic’/‘screening’/‘management’ purposes during impact period (CIP; 23 March 2020 30 September 2020). examined potential in terms of: (1) control people with (2) detection new prediabetes cases. Results In April 2020, test numbers fell by ~80%. Overall, centres, 369 871 were 6.28 months CIP, equivalent >6.6 million nationwide. identified 79 131 ‘monitoring’ diabetes. those 28 564 suboptimal control, this delayed monitoring was associated a 2–3 mmol/mol increase. 149 455 ‘screening’ 141 285 ‘diagnostic’ also missed. Across UK, our findings equate 1.41 missed/delayed (including 0.51 control), 2.67 screening high-risk groups (0.48 within range) 2.52 diagnosis (0.21 pre-diabetes range; ~70 000 range). Conclusions Our illustrate widespread collateral implementing measures mitigate with, or being investigated for, For diabetes, will result further deterioration especially whose levels are already high.