Type 2 diabetes missed or diagnosis delayed for 60,000 UK people in 2020

Researchers investigating the impact of COVID-19 on the NHS in the UK reviewed the health records of 14 million people between March and December 2020 and found that the diagnosis of type 2 diabetes was missed or delayed for 13,700 people. When the findings were expanded to the total population of the UK, the researchers estimated that the figure stands at around 60,000 people.

The research, ‘Impact of COVID-19 on diagnoses, monitoring and mortality in people with Type 2 diabetes in the UK’ was published in The Lancet Diabetes Endocrinology today. It was funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC) which is a partnership between The University of Manchester and Salford Royal hospital.

In April 2020 alone, according to researchers, there was a drop of 70% in recorded diagnoses of the condition compared to expected rates based on 10-year trends in 23 million people. Also, in April, rates of diabetes monitoring (HbA1c blood tests), in people with type 2 diabetes, was reduced by 77% in England, with an 84% reduction across Northern Ireland, Scotland and Wales.

Dr Matthew Carr from The University of Manchester, and lead for this study at the GM PSTRC, said: “Outcomes significantly improve for patients when type 2 diabetes is diagnosed early and regularly monitored. When the condition goes unchecked complications can develop which can be more complex to treat. Prior to the pandemic, diagnosis and monitoring relied upon face-to-face contact so it is no surprise to see an initial reduction, as it just wasn’t possible for patients to receive the necessary level of monitoring. However, to see such a significant drop over the course of 9 months is concerning and is an indication of the challenges faced by healthcare services during the pandemic.”

Outcomes significantly improve for patients when type 2 diabetes is diagnosed early and regularly monitored.
Dr Matthew Carr

The research also revealed a significant reduction in the prescribing of the two drugs commonly used to manage the condition, insulin and metformin. The rates of diagnosing and monitoring were particularly evident in older people, in men and in those from deprived areas.

Dr Carr continued: “Importantly, our research has identified the scale of the problem, along with information on population characteristics. This will help healthcare services to address the backlog of diagnosing, testing and prescribing. Effective communications should ensure that people living with diabetes remain engaged with diabetes services. There also needs to be a greater emphasis on providing relevant information and, when appropriate, glucose monitoring systems with easy data uploads to enable remote support.”

The research looked at mortality rates for people with type 2 diabetes during April 2020 and reported a 110% increase in England. Mortality rate increases were less elevated in Northern Ireland, Scotland and Wales (increase 66%).

Professor Martin K Rutter, from The University of Manchester, Manchester University NHS Foundation Trust, and co-author of the research, said: “In recent years there has been excellent progress made in the management of type 2 diabetes. Resources have been put into early detection and management such that the development of the condition can be delayed and, in some cases, it can be reversed through weight loss interventions. As we recover from the pandemic, our research will help UK healthcare services to focus their efforts on identifying these missed cases and providing more support for people living with diabetes so that they can continue to benefit from these recent advances.”

Nikki Joule, Policy Manager at Diabetes UK, said: "It's incredibly concerning that rates of type 2 diabetes diagnoses in the UK were much lower than previous years during the first part of the COVID-19 pandemic. While figures showed a gradual increase in diagnoses from May to December 2020, they remained well below expected levels.

"These results point towards reduced engagement with healthcare during the pandemic, and highlight the urgent need to ensure that those previously identified by their GP as being at high risk of developing type 2 diabetes receive their annual review. Doing so will ensure that - as appropriate - individuals will receive either a diagnosis, or a referral to the NHS England National Type 2 Diabetes Prevention Programme, or its equivalent.

"Early diagnosis of type 2 diabetes is vital in reducing the risk of serious diabetes-related complications such as problems with the heart, kidneys and eyes. 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 is often linked to being overweight or inactive, or having a family history of the condition. It causes sugar levels in the blood to increase which leads to excessive thirst, weight loss and tiredness. Diabetes, especially when poorly managed, can cause serious long-term problems with the eyes, heart, kidneys and nerves.

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