COVID-19 hinterland: surveilling the self-reported impacts of the pandemic on diabetes management in the USA (cross-sectional results of the iNPHORM study)

Abstract

Main objectiveTo determine how and to what extent COVID-19 has affected real-world, self-reported glycaemic management in Americans with type 1 or type 2 diabetes taking insulin and/or secretagogues, with or without infection.DesignA cross-sectional substudy using data from the Investigating Novel Predictions of Hypoglycemia Occurrence using Real-world Models panel survey.SettingUSA.ParticipantsAmericans 18–90 years old with type 1 or 2 diabetes taking insulin and/or secretagogues were conveniently sampled from a probability-based internet panel.Primary outcome measureA structured, COVID-19-specific questionnaire was administered to assess the impact of the pandemic (irrespective of infection) on socioeconomic, behavioural/clinical and psychosocial aspects of glycaemic management.ResultsData from 667 respondents (type 1 diabetes: 18%; type 2 diabetes: 82%) were analysed. Almost 25% reported A1c values ≥8.1%. Rates of severe and non-severe hypoglycaemia were 0.68 (95% CI 0.5 to 0.96) and 2.75 (95% CI 2.4 to 3.1) events per person-month, respectively. Ten respondents reported a confirmed or probable COVID-19 diagnosis. Because of the pandemic, 24% of respondents experienced difficulties affording housing; 28% struggled to maintain sufficient food to avoid hypoglycaemia; and 19% and 17% reported challenges accessing diabetes therapies and testing strips, respectively. Over one-quarter reported issues retrieving antihyperglycaemics from the pharmacy and over one-third reported challenges consulting with diabetes providers. The pandemic contributed to therapeutic non-adherence (14%), drug rationing (17%) and reduced monitoring (16%). Many struggled to keep track, and in control, of hypoglycaemia (12%–15%) and lacked social support to help manage their risk (19%). Nearly half reported decreased physical activity. Few statistically significant differences were observed by diabetes type.ConclusionsCOVID-19 was found to cause substantial self-reported deficiencies in glycaemic management. Study results signal the need for decisive action to restabilise routine diabetes care in the USA.Trial registration numberNCT04219514.

Blood glucose, blood pressure, and cholesterol testing among adults with diabetes before and during the COVID-19 pandemic, USA, 2019 vs 2021

“…A US study conducted in April 2020 determined that 40% of participants’ diabetes-related appointments were cancelled or postponed 7. Another US study found that, among adults with diabetes taking insulin and/or secretagogues, the pandemic was associated with an increase in therapeutic non-adherence and difficulty in testing and monitoring blood glucose 6. Another US study based on laboratory data from Quest Diagnostics reported a reduced A1c testing volume by as much as 66% in March and April 2020 compared with testing volumes between January 2019 and February 2020 4…”

“…Delayed medical care among persons with diabetes may be higher than average since those with diabetes or complications of diabetes are known to have more adverse outcomes from COVID-19 than persons without diabetes 3. Literature on the potential impact of the COVID-19 pandemic on healthcare utilization and diabetes-related testing among adults is growing with some studies showing reductions in A1c testing4–6 and outpatient visits5 7 in selected populations. However, it is unclear whether disruptions to medical care are associated with diabetes management, including regular recommended testing for A1c, blood pressure (BP), and cholesterol (ABC).…”

Real‐world risk factors of confirmed or probable COVID‐19 in Americans with diabetes: A prospective, community‐based study (iNPHORM)

“… 27 As hypoglycaemia is known to induce inflammation, including IL‐6 expression, and decrease immune responsiveness, it is not surprising that it may also exacerbate biologic predisposition to infection. 25 Amid challenges to sustain routine diabetes care during the pandemic, 28 it is essential that efforts to optimize glucose management not wane.…”

Predicting Real-world Hypoglycemia Risk in American Adults With Type 1 or 2 Diabetes Mellitus Prescribed Insulin and/or Secretagogues: Protocol for a Prospective, 12-Wave Internet-Based Panel Survey With Email Support (the iNPHORM [Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-world Models] Study)

“…Pandemic-related items were added after study commencement in response to the escalating severity of the COVID-19 pandemic. Beginning with subpanel A wave 2 (April 21 to April 28, 2020), each follow-up contained a 25-item COVID-19 subquestionnaire that assessed self-reported infection status (per Centers for Disease Control and Prevention’s community case definitions [April 2020]; [ 58 ]) and the impact of the pandemic situation on socioeconomic, clinical, and psychosocial aspects of diabetes management [ 59 ].…”