Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA.
BMJ Open Diabetes Res Care. 2023 Jul;11(4). doi: 10.1136/bmjdrc-2023-003466.
We investigated the impact of the COVID-19 pandemic on annual adherence to seven diabetes care guidelines and risk factor management among people with diabetes.
We included all adults (aged ≥18 years) with prevalent diabetes as of 1 January 2018, who were continuously enrolled at Kaiser Permanente Georgia (KPGA) through 31 December 2021 (n=22 854). Prevalent diabetes was defined as a history of at least one of a diagnosis code for diabetes, use of antihyperglycemic medication, or at least one laboratory value of HbA1c, fasting plasma glucose or random glucose in the diabetic range. We defined pre-COVID (2018-2019) and during COVID (2020-2021) cohorts. Cohort-specific laboratory measurements (ie, blood pressure (BP), HbA1c, cholesterol, creatinine, urine-albumin-creatinine ratio (UACR)) and procedures (ie, eye and foot examinations) were determined from KPGA's electronic medical record data. We used logistic generalized estimating equations (GEE), adjusted for baseline age, to assess the within-subject change in guideline adherence (ie, at least one measurement per year per period) from pre-COVID to during COVID era overall, and by age, sex, and race. Linear GEE compared mean laboratory measurements pre and during COVID.
The proportion of adults meeting each of the seven diabetes care guidelines decreased significantly during (vs pre) COVID (range in absolute reductions: -0.8% to -11.2%) with greatest reductions seen for BP (-11.2%) and cholesterol (-8.8%). Declines were similar across age, sex, and race subgroups. Average HbA1c and systolic BP increased 0.11% and 1.6 mmHg, respectively, while low-density lipoprotein cholesterol declined 8.9 mg/dL. The proportion of adults at high risk of kidney disease (ie, UACR ≥300 mg/g) increased from 6.5% to 9.4%.
In an integrated healthcare system, the proportion of people with diabetes meeting guideline-recommended screenings decreased during the pandemic, coinciding with worsening glucose, kidney, and (some) cardiovascular risk profiles. Follow-up is needed to assess the long-term implications of these care gaps.
我们研究了 COVID-19 大流行对糖尿病患者遵医嘱进行七种糖尿病护理指南以及管理风险因素的年度依从性的影响。
我们纳入了 2018 年 1 月 1 日起在佐治亚州凯撒永久医疗集团（KPGA）连续注册的所有成年患者（年龄≥18 岁），并确诊为糖尿病（有糖尿病诊断代码、使用降血糖药物、或至少有一次糖化血红蛋白、空腹血糖或随机血糖在糖尿病范围内的实验室值）。我们将患者分为大流行前（2018-2019 年）和大流行期间（2020-2021 年）两组。两组的实验室测量值（如血压（BP）、糖化血红蛋白、胆固醇、肌酐、尿白蛋白/肌酐比值（UACR））和程序（如眼部和足部检查）均来自 KPGA 的电子病历数据。我们使用逻辑广义估计方程（GEE），根据基线年龄进行调整，评估了大流行前和大流行期间总体上、以及按年龄、性别和种族划分的指南遵守情况（即每年每个时期至少进行一次测量）的个体内变化。线性 GEE 比较了 COVID 前后的平均实验室测量值。
与大流行前相比，在大流行期间，符合七种糖尿病护理指南的成年人比例显著下降（绝对降幅范围：-0.8%至-11.2%），降幅最大的是血压（-11.2%）和胆固醇（-8.8%）。各年龄、性别和种族亚组的下降情况相似。平均糖化血红蛋白和收缩压分别升高了 0.11%和 1.6mmHg，而低密度脂蛋白胆固醇下降了 8.9mg/dL。患有肾脏疾病（即 UACR≥300mg/g）的成年人比例从 6.5%增加到 9.4%。
在一个综合性医疗保健系统中，在大流行期间，符合指南推荐的筛查标准的糖尿病患者比例下降，同时血糖、肾脏和（某些）心血管风险状况恶化。需要进行后续评估以评估这些护理差距的长期影响。
