Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana.
Endocr Pract. 2023 Jul;29(7):529-537. doi: 10.1016/j.eprac.2023.04.009. Epub 2023 Apr 28.
We examined diabetes outpatient management during the first 2 years of the Coronavirus Disease 2019 pandemic in an endocrinology practice with a focus on health care disparities in outcomes.
We conducted a retrospective cohort study examining adults with diabetes during 3 time periods: T1 (March 2019-February 2020), T2 (March 2020-February 2021), and T3 (March 2021-February 2022). Clinical outcomes included body mass index (BMI), systolic blood pressure (SBP), Hemoglobin A1c (HgbA1c), low-density lipoprotein cholesterol (LDL), and urine albumin:creatinine ratio. Appointment types (virtual vs in-person) were also collected.
Frequencies of HgbA1c, BMI, and SBP measurements reduced by 36.0%, 46.3%, and 48.5% in T2, respectively, and remaining 8.7% (HgbA1c), 13.4% (BMI), and 15.2% (SBP) lower at the end of the study period (P < .001) compared to prepandemic levels. However, the average HgbA1c and LDL slightly improved. Clinic appointments per patient increased during the pandemic, fueled by telehealth utilization. Women had fewer in-person visits during T2, those older than 65 had better HgbA1c, and the most socioeconomically deprived group had the worst HgbA1c during every time period. In addition, black patients had worse HgbA1c, LDL, and SBP values throughout the study, which did not worsen over the pandemic.
While the frequency of health measurements had not fully recovered 2 years into the pandemic, this did not translate to worse diabetes management or a widening of pre-existing disparities. Our study emphasizes the role of equitable health care in minimizing inequalities in diabetes, particularly during times of crisis.
我们研究了一家内分泌诊所 2019 冠状病毒病大流行的头 2 年中糖尿病患者的门诊管理情况，重点关注结果方面的医疗保健差异。
我们进行了一项回顾性队列研究，在三个时间段内检查了患有糖尿病的成年人：T1（2019 年 3 月至 2020 年 2 月）、T2（2020 年 3 月至 2021 年 2 月）和 T3（2021 年 3 月至 2022 年 2 月）。临床结果包括体重指数（BMI）、收缩压（SBP）、糖化血红蛋白（HgbA1c）、低密度脂蛋白胆固醇（LDL）和尿白蛋白：肌酐比值。还收集了预约类型（虚拟与面对面）。
T2 时 HgbA1c、BMI 和 SBP 的测量频率分别降低了 36.0%、46.3%和 48.5%，在研究结束时仍分别低 8.7%（HgbA1c）、13.4%（BMI）和 15.2%（SBP）（P<0.001）。然而，平均 HgbA1c 和 LDL 略有改善。大流行期间，远程医疗的使用推动了诊所就诊次数的增加。T2 期间，女性面对面就诊次数减少，65 岁以上患者的 HgbA1c 更好，社会经济地位最低的人群在每个时间段的 HgbA1c 最差。此外，黑人患者在整个研究过程中 HgbA1c、LDL 和 SBP 值较差，大流行期间并未恶化。
尽管大流行 2 年后健康测量的频率尚未完全恢复，但这并未转化为糖尿病管理的恶化或现有差异的扩大。我们的研究强调了公平医疗保健在最大限度地减少糖尿病中的不平等，尤其是在危机时期的作用。
