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Original research
Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing: implications for diabetes management and diagnosis
  1. David Holland1,
  2. Adrian H Heald2,3,
  3. Mike Stedman4,
  4. Fahmy Hanna5,6,
  5. Pensee Wu7,8,
  6. Christopher Duff8,9,
  7. Lewis Green10,
  8. Sarah Robinson9,
  9. Ian Halsall11,
  10. Neil Gaskell12,
  11. John Pemberton13,
  12. Christine Bloor13,
  13. Anthony A Fryer8,9
  1. 1The Benchmarking Partnership, Alsager, UK
  2. 2Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
  3. 3The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
  4. 4Res Consortium, Andover, UK
  5. 5Department of Diabetes and Endocrinology, Univerisity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  6. 6Centre for Health and Development, Staffordshire University Faculty of Health Sciences, Stoke-on-Trent, UK
  7. 7Academic Department of Obstetrics and Gynaecology, Univerisity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  8. 8School of Medicine, Keele University, Keele, UK
  9. 9Department of Clinical Biochemistry, Univerisity Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  10. 10Department of Clinical Biochemistry, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
  11. 11Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, UK
  12. 12Department of Pathology, Warrington & Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
  13. 13Diabetes UK (North Staffordshire Branch), Stoke, UK
  1. Correspondence to Professor Anthony A Fryer, School of Medicine, Keele University, Keele, Staffordshire, UK; a.a.fryer{at}keele.ac.uk

Abstract

Aims The COVID-19 pandemic, and the focus on mitigating its effects, has disrupted diabetes healthcare services worldwide. We aimed to quantify the effect of the pandemic on diabetes diagnosis/management, using glycated haemoglobin (HbA1c) as surrogate, across six UK centres.

Methods Using routinely collected laboratory data, we estimated the number of missed HbA1c tests for ‘diagnostic’/‘screening’/‘management’ purposes during the COVID-19 impact period (CIP; 23 March 2020 to 30 September 2020). We examined potential impact in terms of: (1) diabetes control in people with diabetes and (2) detection of new diabetes and prediabetes cases.

Results In April 2020, HbA1c test numbers fell by ~80%. Overall, across six centres, 369 871 tests were missed during the 6.28 months of the CIP, equivalent to >6.6 million tests nationwide. We identified 79 131 missed ‘monitoring’ tests in people with diabetes. In those 28 564 people with suboptimal control, this delayed monitoring was associated with a 2–3 mmol/mol HbA1c increase. Overall, 149 455 ‘screening’ and 141 285 ‘diagnostic’ tests were also missed. Across the UK, our findings equate to 1.41 million missed/delayed diabetes monitoring tests (including 0.51 million in people with suboptimal control), 2.67 million screening tests in high-risk groups (0.48 million within the prediabetes range) and 2.52 million tests for diagnosis (0.21 million in the pre-diabetes range; ~70 000 in the diabetes range).

Conclusions Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for, diabetes. For people with diabetes, missed tests will result in further deterioration in diabetes control, especially in those whose HbA1c levels are already high.

  • diabetes mellitus
  • diagnosis
  • COVID-19

Data availability statement

Data are available upon reasonable request. Data are available on reasonable request from the authors.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/jclinpath-2021-207776

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    Data availability statement

    Data are available upon reasonable request. Data are available on reasonable request from the authors.

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    Footnotes

    • Handling editor Tahir S Pillay.

    • Contributors AAF, DH, AHH and MS devised the original concept. CD, LG, SR, IH and NG were responsible for extraction and initial cleaning of the data from laboratory records at each of the six centres. DH and AAF performed the data manipulation and analysis. AHH, FH, PW and AAF provided the clinical interpretation. CD, LG, SR, IH and NG provided data quality checking and interpretation of results from each of their respective centres. CB and JP provided a patient perspective and interpretation of the study findings as part of their long-standing relationship with AAF, FH and CD. AAF, AHH, MS, DH, PW and FH wrote the initial draft of the paper, which was then critiqued by all other authors as part of regular team meetings and manuscript revision process. All authors approved the final version of the manuscript.

    • Funding This study as supported by a National Institute for Health Research Healthcare Scientist Fellowship award (HCS/08/011), supervised by AAF.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.