Impact of COVID-19 on the diagnoses, HbA1c monitoring and mortality in people with type 2 diabetes: a UK-wide cohort study involving 13 million people in primary care

AIMSTo compare trends in diagnoses, monitoring and mortality in patients with type 2 diabetes, before and after the first COVID-19 peak. METHODSWe constructed a cohort of 25 million patients using electronic health records from 1831 UK general practices registered with the Clinical Practice Research Datalink (CPRD), including 14 million patients followed between March and December 2020. We compared trends using regression models and 10-year historical data. We extrapolated the number of missed/delayed diagnoses using UK Office for National Statistics data. RESULTSIn England, rates of new type 2 diabetes diagnoses were reduced by 70% (95% CI 68%-71%) in April 2020, with similar reductions in Northern Ireland, Scotland and Wales. Between March and December, we estimate that there were approximately 60,000 missed/delayed diagnoses across the UK. In April, rates of HbA1c testing were greatly reduced in England (reduction: 77% (95% CI 76%-78%)) with more marked reductions in the other UK nations (83% (83-84%)). Reduced rates of diagnosing and monitoring were particularly evident in older people, in males, and in those from deprived areas. In April, the mortality rate in England was more than 2-fold higher (112%) compared to prior trends, but was only 65% higher in Northern Ireland, Scotland and Wales. CONCLUSIONSAs engagement increases, healthcare services will need to manage the backlog and anticipate greater deterioration of glucose control due to delayed diagnoses and reduced monitoring in those with pre-existing diabetes. Older people, men, and those from deprived backgrounds will be groups to target for early intervention. RESEARCH IN CONTEXTO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIThe higher COVID-related death rate in people with diabetes has been well-documented C_LIO_LIA study involving the residents of Salford, UK showed 135 fewer diagnoses of type 2 diabetes than expected between March and May 2020, which amounted to a 49% reduction in activity C_LIO_LIThere is limited data on the impact of the COVID-19 pandemic on the diagnosis and monitoring of type 2 diabetes C_LI What is the key question?O_LIWhat has been the impact of the COVID-19 pandemic on the diagnosis and monitoring of type 2 diabetes across the UK? C_LI What are the new findings?O_LIAcross the UK, the rate of new type 2 diabetes diagnoses was reduced by up to 70% in April 2020 compared to 10-year historical trends C_LIO_LIBetween March and December 2020, it is estimated that 60,000 people have had a missed or delayed diagnosis C_LIO_LIThe frequency of HbA1c monitoring in type 2 diabetes was reduced by 77-83% in April 2020 and by 31-37% overall between March and December 2020 C_LI How might this impact on clinical practice in the foreseeable future?O_LIDuring this pandemic and associated lockdowns, effective public communications should ensure that patients remain engaged with diabetes services including HbA1c screening and monitoring C_LI