Senthinathan A, Tu K, Stephenson E, O'Neill B, Lipscombe L, Ji C, Butt D A, Apajee J, Train A, Crampton N
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
North York General Hospital, Toronto, ON, Canada.
BMC Prim Care. 2024 Jan 27;25(1):43. doi: 10.1186/s12875-024-02272-0.
With the onset of the COVID-19 pandemic and the large uptake in virtual care in primary care in Canada, the care of patients with type 2 diabetes has been greatly affected. This includes decreased in-person visits, laboratory testing and in-person assessments such as blood pressure (BP). No studies have investigated if these changes persisted with pandemic progression, and it is unclear if shifts impacted patient groups uniformly. The purpose of this paper was to examine changes in diabetes care pre, early, and later pandemic across different patient groups.
A repeated cross-sectional design with an open cohort was used to investigate diabetes care in adults with type 2 diabetes for a 6-month interval from March 14 to September 13 over three consecutive years: 2019 (pre-pandemic period), 2020 (early pandemic period), and 2021 (later pandemic period). Data for this study were abstracted from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a primary care electronic medical records database in Ontario, Canada. Changes in diabetes care, which included primary care total visits, in-person visits, hemoglobin A1c (HbA1c) testing, and BP measurements were evaluated across the phases of the pandemic. Difference in diabetes care across patient groups, including age, sex, income quintile, prior HbA1c levels, and prior BP levels, were assessed.
A total of 39,401 adults with type 2 diabetes were included in the study. Compared to the 6-month pre-pandemic period, having any in-person visits decreased significantly early pandemic (OR = 0.079 (0.076-0.082)), with a partial recovery later pandemic (OR = 0.162 (95% CI: 0.157-0.169). Compared to the pre-pandemic period, there was a significant decrease early pandemic for total visits (OR = 0.486 (95% CI: 0.470-0.503)), HbA1c testing (OR = 0.401 (95% CI: 0.389-0.413)), and BP measurement (OR = 0.121 (95% CI: 0.116-0.125)), with partial recovery later pandemic.
All measures of diabetes care were substantially decreased early pandemic, with a partial recovery later pandemic across all patient groups. With the increase in virtual care due to the COVID-19 pandemic, diabetes care has been negatively impacted over 1-year after pandemic onset.
随着新冠疫情的爆发以及加拿大初级医疗中虚拟医疗的大量采用，2型糖尿病患者的护理受到了极大影响。这包括面对面就诊次数减少、实验室检查以及诸如血压（BP）等面对面评估的减少。尚无研究调查这些变化是否随着疫情的发展而持续存在，并且不清楚这些变化是否对所有患者群体产生了一致的影响。本文的目的是研究疫情前、早期和后期不同患者群体中糖尿病护理的变化。
采用开放队列的重复横断面设计，对2型糖尿病成人患者的糖尿病护理情况进行为期6个月的调查，时间跨度为连续三年的3月14日至9月13日：2019年（疫情前时期）、2020年（疫情早期）和2021年（疫情后期）。本研究的数据摘自加拿大多伦多大学基于实践的研究网络（UTOPIAN）数据安全港，这是加拿大安大略省的一个初级医疗电子病历数据库。评估了疫情各阶段糖尿病护理的变化，包括初级医疗总就诊次数、面对面就诊次数、糖化血红蛋白（HbA1c）检测以及血压测量。评估了不同患者群体（包括年龄、性别、收入五分位数、既往HbA1c水平和既往血压水平）在糖尿病护理方面的差异。
共有39401名2型糖尿病成人患者纳入本研究。与疫情前的6个月相比，疫情早期面对面就诊的人数显著减少（OR = 0.079（0.076 - 0.082）），疫情后期有所部分恢复（OR = 0.162（95%CI：0.157 - 0.169））。与疫情前时期相比，疫情早期总就诊次数（OR = 0.486（95%CI：0.470 - 0.503））、HbA1c检测（OR = 0.401（95%CI：0.389 - 0.413））和血压测量（OR = 0.121（95%CI：0.116 - 0.125））均显著减少，疫情后期有所部分恢复。
疫情早期所有糖尿病护理指标均大幅下降，疫情后期所有患者群体均有所部分恢复。由于新冠疫情导致虚拟医疗增加，疫情爆发1年后糖尿病护理受到了负面影响。
