RT Journal Article
SR Electronic
T1 Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing: implications for diabetes management and diagnosis
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 177
OP 184
DO 10.1136/jclinpath-2021-207776
VO 76
IS 3
A1 Holland, David
A1 Heald, Adrian H
A1 Stedman, Mike
A1 Hanna, Fahmy
A1 Wu, Pensee
A1 Duff, Christopher
A1 Green, Lewis
A1 Robinson, Sarah
A1 Halsall, Ian
A1 Gaskell, Neil
A1 Pemberton, John
A1 Bloor, Christine
A1 Fryer, Anthony A
YR 2023
UL http://jcp.bmj.com/content/76/3/177.abstract
AB 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.Data are available upon reasonable request. Data are available on reasonable request from the authors.