Routine care for people with newly diagnosed type 2 diabetes before and during the SARS-CoV-2 pandemic – results from the German Disease Analyzer database

Highlights

• In Germany, diabetes incidence was temporarily reduced at the onset of the pandemic.

• Diabetes incidence returned to normal by June 2020.

• HbA1c at diabetes diagnosis was slightly higher during than before the pandemic.

• The volume of physician care was slightly lower during the pandemic than before.

• There was no reduction in new diabetes drug prescriptions during the pandemic.

Abstract

Aim

To investigate whether the SARS-CoV-2 pandemic affected care for people with newly diagnosed type 2 diabetes in Germany.

Methods

The Disease Analyzer database (IQVIA, Germany) contains routine data on diagnoses and treatments (ICD-10 and ATC codes) from patients followed in selected physician practices across Germany. We compared 21,747 individuals with a first diagnosis of type 2 diabetes between January 2018 and September 2019 with 20,513 individuals with a first diabetes diagnosis between March 2020 and November 2021.

Results

In March and April 2020, the number of new diagnoses of diabetes decreased by 18.3% and 35.7%, respectively, compared to March and April of the previous two years. The previous diabetes incidence level was reached again in June 2020. Mean pre-treatment glucose levels were higher during the pandemic than before (fasting plasma glucose: +6.3 mg/dl (95% confidence interval: 4.6–8.0)). In the first six months after diabetes diagnosis, the mean number of GP visits, specialist referrals and HbA1c measurements decreased.

Conclusion

We observed a decrease in diabetes incidence in the early phase of the pandemic and slightly higher pretreatment blood glucose levels during the pandemic than before. Care for newly diagnosed diabetes was slightly worse during the pandemic than before.

Introduction

COVID-19 was reported to have severe direct effects on people with diabetes. Patients with COVID-19 have worse outcomes if they also have diabetes, and infected persons with type 1 or type 2 diabetes have a higher mortality risk than infected persons without diabetes [1], [2], [3], [4]. The mortality risk is particularly high in patients with COVID-19 and pre-existing diabetes with poorly controlled glucose metabolism [3], [4]. In addition, there is evidence that the risk of diabetes manifestation is increased in people with COVID-19 [5].

There are also indirect adverse effects of COVID-19 on medical care. Routine diabetes care may have been disrupted or compromised for several reasons, e.g., reduction of face-to-face contacts with general practitioners and specialists, shortage of medical staff, decreased hospital capacities, or delayed health care seeking of patients [6], [7]. In the early stages of the pandemic, several online surveys suggested that routine care for people with diabetes was severely affected [8], [9], [10]. In England, only 26.5% of persons with diabetes received all eight care processes recommended by the National Institute for Health and Care Excellence (NICE) between April 2020 and March 2021 compared to 48.1% between April 2019 and March 2020 [11]. In people with type 2 diabetes from UK general practices, a large reduction in the frequency of health checks was observed between March and December 2020 compared to expected frequencies estimated from 10 years of historical data: for example, percentage reductions of 31.2%, 47.2%, and 30.5%, respectively, were observed for measurements of HbA1c, blood pressure, and serum cholesterol [12]. A study on persons with diabetes from Tuscany in Italy showed that the proportion of patients with at least one measurement of HbA1c was lower in 2020 (59%) than in 2019 (68%); moreover, the number of specialist visits was reduced by 17.4% [13].

Disruption of routine care during the pandemic had a strong negative impact on mortality risk and the risk of diabetes complications. In England, persons with diabetes who did not receive all eight care processes recommended by NICE had an increased risk also for Non-COVID-19 related mortality in the first year after the onset of the pandemic [11]. In people with type 2 diabetes, attainment of primary care indicators was shown to reduce mortality risk, the risk of diabetic retinopathy and of lower limb amputations, and to reduce emergency hospital admissions [14], [15], [16], [17]. Reductions in routine care delivery during the pandemic may therefore have severe long-term risks for people with diabetes.

The present study focused on the routine care for persons with newly diagnosed type 2 diabetes in Germany. Our aim was threefold: First, to assess whether the rate of incident diabetes was reduced during the pandemic. Second, to assess whether plasma glucose levels, lipid levels, and blood pressure at the time of diabetes diagnosis depended on whether diabetes was diagnosed before or during the pandemic. Third, to compare patients with a first diagnosis of diabetes before and during the pandemic with regard to diabetes treatment in the first six months after diagnosis.