Enforced inactivity in the elderly and diabetes risk: initial estimates of the burden of an unintended consequence of COVID-19 lockdown

BackgroundOlder adults and those with underlying health conditions were advised to stay at home to help reduce the spread of COVID-19 however little advice on regular physical activity was given to those at risk. We modelled the effects of enforced inactivity on diabetes burden using published evidence. MethodsUsing Health Survey for England data, we estimated the prevalence of pre-diabetes and physical activity in adults aged 70 and older. The number of new diabetes cases directly attributed to lockdown were calculated using population attributable risk. Unit cost estimates of the additional burden on primary care and the cost of complications to secondary care were taken from the literature. ResultsFrom 9 million older ([&ge;]70yrs) people living in England, 2.1 million could be defined as pre-diabetic (glycated haemoglobin 42<48 mmol/mol). The estimated population attributable fraction (0.281) (assuming relative risk of diabetes from inactivity=3.3, 40% physically active) would give rise to 392,948 new cases of diabetes which we argue are directly attributed to a prolonged period of lockdown. We estimate that the cost of screening and testing these patients in primary care ({pound}35m), their subsequent treatment and management ({pound}229m), and complications ({pound}909m) would equate to an additional {pound}1.17bn to the health care system. ConclusionsInactivity related to lockdown in previously active older adults may contribute up to {pound}1.17b in additional healthcare costs through a potential increase in diabetes. Clear advice about the importance of physical activity may reduce this potential economic burden during global pandemics.