First Covid lockdown had major impact on type 2 diabetes diagnosis and monitoring
New diagnoses for type 2 diabetes within a UK cohort of 13 million people were 70% down in the month of April 2020, compared to expected rates based on 10-year trends in 23 million people, according to new research.
The research was funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), a partnership between The University of Manchester and Salford Royal hospital.
Overall, data from between March and July 2020 showed the rate of diagnosis for type 2 diabetes in English practices was reduced by 46% with smaller reductions of 37% in Northern Ireland, Scotland and Wales.
Over that period, the researchers estimate there were more than 45,000 missed or delayed diagnoses for type 2 diabetes across the UK.
In April, rates of diabetes monitoring (HbA1c blood tests) in people with type 2 diabetes reduced by 77% in England, with a 84% reduction across Northern Ireland, Scotland and Wales.
The study also found that the reduced rates of diagnosing and HbA1c monitoring in people with type 2 diabetes were particularly evident in older people, in men, and in those from deprived areas.
In April 2020, mortality rates in people with type 2 diabetes in England were more than twice as high compared to prior trends (mortality rate increase: 110%), but mortality rate increases were less elevated in Northern Ireland, Scotland and Wales (increase 66%).
The research team, who have published an early draft of the pre-peer reviewed study, say that further research is required to understand how population characteristics including ethnicity, population density and deprivation might explain the differences in mortality rate across UK nations.
Dr Matthew Carr from The University of Manchester, and lead for this study at the GM PSTRC, said: “The high rate of COVID-19 infection since August and the second national lockdown makes our results intensely relevant."
“Healthcare services will need to manage this backlog of work, and the expected increase in the severity of diabetes brought about by delayed diagnoses,” said co-author Professor Martin Rutter, from The University of Manchester.
“As we address this backlog of work, older individuals, males and people from deprived backgrounds may be a group to target for HbA1c testing and treatment intensification,” said co-author and Deputy Director at the GM PSTRC, Professor Darren Ashcroft from The University of Manchester.
Nikki Joule, Policy Manager at Diabetes UK, said: “These shocking results highlight the urgent need to ensure that those identified by their GP as being at high risk of developing type 2 diabetes, receive their annual screening for diabetes.
“In addition, while the challenges caused by the pandemic persist, if we are to ensure that people living with type 2 diabetes don’t miss out on annual health checks and HbA1C tests, it is vital that those who need an appointment, are offered one. To find out your risk of type 2 diabetes, visit Diabetes UK’s Know Your Risk Tool – and if you’re concerned that you might be at an increased risk, it’s important to speak to your GP.”
Type 2 diabetes accounts for around 90% of all diabetes diagnoses, and causes the level of sugar in the blood to become too high. It can cause symptoms like excessive thirst and tiredness and as well as serious problems in the eyes, heart and nerves.
Co-author, Alison Wright, from The University of Manchester added: “This second national lockdown could have devastating consequences on the care of people with diabetes without effective planning.“
The authors of the study feel the paper should be widely seen as a matter of urgency, hence their decision to make it available to the media before peer review.
The paper 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 is available here