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

Holland, David; Heald, Adrian H; Stedman, Mike; Hanna, Fahmy; Wu, Pensee; Duff, Christopher; Green, Lewis; Robinson, Sarah; Halsall, Ian; Gaskell, Neil; Pemberton, John; Bloor, Christine; Fryer, Anthony A

Authors

David Holland

Adrian H Heald

Mike Stedman

Fahmy Hanna

Christopher Duff

Lewis Green

Sarah Robinson

Ian Halsall

Neil Gaskell

John Pemberton

Christine Bloor



Abstract

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

Journal Article Type Article
Acceptance Date Sep 8, 2021
Online Publication Date Feb 17, 2023
Publication Date Oct 13, 2021
Journal Journal of Clinical Pathology
Print ISSN 0021-9746
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 76
Issue 3
DOI https://doi.org/10.1136/jclinpath-2021-207776
Publisher URL https://jcp.bmj.com/content/early/2021/10/12/jclinpath-2021-207776