2019年冠状病毒病大流行对糖化血红蛋白检测的影响：高危病例的优先排序及社会剥夺的影响
The Effect of the COVID-19 Pandemic on HbA1c Testing: Prioritization of High-Risk Cases and Impact of Social Deprivation.
作者信息
Holland David, Heald Adrian H, Hanna Fahmy F W, Stedman Mike, Wu Pensée, Sim Julius, Duff Christopher J, Duce Helen, Green Lewis, Scargill Jonathan, Howe Jonathon D, Robinson Sarah, Halsall Ian, Gaskell Neil, Davison Andrew, Simms Mark, Denny Angela, Langan Martin, Fryer Anthony A
机构信息
The Benchmarking Partnership, Alsager, Cheshire, UK.
Department of Diabetes and Endocrinology, Salford Royal Hospital, The Northern Care Alliance NHS Foundation Trust, Salford, UK.
出版信息
Diabetes Ther. 2023 Apr;14(4):691-707. doi: 10.1007/s13300-023-01380-x. Epub 2023 Feb 22.
INTRODUCTION
Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control and demographic characteristics.
METHODS
In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics.
RESULTS
In April 2020, monthly requests dropped to 7.9-18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7-86.9% of 2019 levels. During April-June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4-63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April-June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April-June 2020; trend test p < 0.001) and two subsequent periods (July-September and October-December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group.
CONCLUSION
Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59-86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality.
引言
研究表明，新冠疫情对糖尿病患者以及弱势群体的影响尤为严重。在英国封锁的前6个月，超过660万次糖化血红蛋白（HbA1c）检测被遗漏。我们现在报告HbA1c检测恢复情况的变异性，及其与糖尿病控制和人口统计学特征的关联。
方法
在一项服务评估中，我们调查了2019年1月至2021年12月期间英国10个地点（代表英格兰9.9%的人口）的HbA1c检测情况。我们将2020年4月的月度检测请求与2019年同期的请求进行了比较。我们研究了（i）HbA1c水平、（ii）不同医疗机构之间的变异性以及（iii）医疗机构人口统计学特征的影响。
结果
2020年4月，月度检测请求降至2019年水平的7.9%-18.1%。到2020年7月，检测量恢复到2019年水平的61.7%-86.9%。在2020年4月至6月期间，我们观察到全科医疗中HbA1c检测减少幅度存在5.1倍的差异（为2019年水平的12.4%-63.8%）。有证据表明，在2020年4月至6月期间，HbA1c>86 mmol/mol的患者检测优先级有限（占总检测量的4.6%，而2019年为2.6%）。在第一次封锁期间（2020年4月至6月；趋势检验p<0.001）以及随后的两个时期（2020年7月至9月和10月至12月；均p<0.001），社会劣势最高地区的检测量较低。到2021年2月，最贫困组的检测量累计下降至2019年水平的34.9%，而最不贫困组为24.6%。
结论
我们的研究结果突出表明，疫情应对措施对糖尿病监测和筛查产生了重大影响。尽管HbA1c>86 mmol/mol组的检测优先级有限，但这并未认识到59-86 mmol/mol组的患者需要持续监测以实现最佳治疗效果。我们的研究结果进一步证明，背景较差的人群受到的不利影响更大。医疗服务机构应纠正这种健康不平等现象。
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