School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia
School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia.
Fam Med Community Health. 2023 Aug;11(3). doi: 10.1136/fmch-2023-002271.
The COVID-19 pandemic disrupted general practice worldwide, primarily due to public health measures that restricted access to care for chronic diseases, such as type 2 diabetes. These measures disproportionately affected higher risk groups with type 2 diabetes, such as older people and those with obesity. This study aims to identify factors that may have influenced the rates of compliance with testing guidelines and target glycaemic control in Australian general practice settings during the COVID-19 pandemic.
We used a serial cross-sectional study design of patient record data from general practices representative of the Nepean Blue Mountains Local Health District between 2020 and 2022. Aggregated patient records were analysed to determine percentages of subgroups with a blood glycaemic testing interval consistent with guidelines (≥1 within 15 months) and achieving target glycaemic control (by glycated haemoglobin of ≤7%). Linear regression models were used to test the association between independent and dependent variables, and to generate regression coefficients and 95% CI, corrected for time trends.
Of the average 14 356 patient records per month, 55% were male, 53% had a body mass index (BMI) <30 and 55% were aged 55-74 years. Compliance to testing guidelines slightly decreased (75-73%) but was positively associated with male sex (2.5%, 95% CI 1.7%, 3.4%), BMI≥30 (9.6%, 95% CI 8.8%, 10.4%) and 55-74 years (7.5%, 95% CI 6.6%, 8.5%) and 75 years and over age groups (7.1%, 95% CI 6.2%, 7.9%). Mean percentage of patient records achieving target glycaemic control slightly increased and was negatively associated with male sex (-3.7%, 95% CI -5.2%, -2.2%), but positively associated with 55-74 years (4.5%, 95% CI 3.8%, 5.1%) and 75 years and over age groups (12.2%, 95% CI 4.5%, 20.0%). Compliance to testing guidelines increased with each additional general practice per 10 000 persons (8.4%, 95% CI 4.9%, 11.8%).
During the COVID-19 pandemic, people with type 2 diabetes in Australia continued to follow glycaemic testing guidelines at the same rate. In fact, there was a slight improvement in glycaemic control among all subgroups of patients, including those at higher risk. These findings are encouraging, but the longer term impact of COVID-19 on type 2 diabetes care is still unclear.
COVID-19 大流行在全球范围内扰乱了全科医学，主要是由于公共卫生措施限制了对慢性病（如 2 型糖尿病）的护理。这些措施对患有 2 型糖尿病的高危人群（如老年人和肥胖者）产生了不成比例的影响。本研究旨在确定可能影响澳大利亚全科医疗环境中 COVID-19 期间检测指南的遵守率和目标血糖控制率的因素。
我们使用了 2020 年至 2022 年间代表 Nepean Blue Mountains 地方卫生区的一般实践的患者记录的串联横断面研究设计。对汇总的患者记录进行分析，以确定符合指南的血糖检测间隔的亚组百分比（15 个月内≥1 次）和达到目标血糖控制的百分比（糖化血红蛋白≤7%）。线性回归模型用于测试独立和因变量之间的关联，并生成回归系数和 95%CI，经时间趋势校正。
每月平均有 14356 份患者记录，其中 55%为男性，53%的体重指数（BMI）<30，55%年龄在 55-74 岁之间。检测指南的依从性略有下降（75-73%），但与男性（2.5%，95%CI 1.7%-3.4%）、BMI≥30（9.6%，95%CI 8.8%-10.4%）和 55-74 岁（7.5%，95%CI 6.6%-8.5%）和 75 岁及以上年龄组（7.1%，95%CI 6.2%-7.9%）呈正相关。达到目标血糖控制的患者记录的平均百分比略有增加，与男性（-3.7%，95%CI-5.2%-2.2%）呈负相关，但与 55-74 岁（4.5%，95%CI 3.8%-5.1%）和 75 岁及以上年龄组（12.2%，95%CI 4.5%-20.0%）呈正相关。每增加 10000 人/间的全科医生，检测指南的依从性增加 8.4%（95%CI 4.9%-11.8%）。
在 COVID-19 大流行期间，澳大利亚的 2 型糖尿病患者继续遵循血糖检测指南的相同比率。事实上，所有患者亚组的血糖控制都有轻微改善，包括高危人群。这些发现令人鼓舞，但 COVID-19 对 2 型糖尿病护理的长期影响仍不清楚。
