COVID-19 Pandemic Has Made Diabetes Management More Difficult for US Patients

Survey data from more than 700 patients within the US is providing insight into the effects of the COVID-19 pandemic on disease management among patients with diabetes.

Leveraging data from a cohort of patients taking part in monthly surveys as part of another study, results of the analysis detail low levels of medication of adherence, financial difficulties, and additional burdens of stress as a result of the COVID-19 pandemic.

“Our findings help us to understand the hidden toll the COVID-19 pandemic has taken on those with chronic diseases like diabetes”, says lead author Alexandria Ratzki-Leewing, MSc, from Western University, London, Canada, in a statement. “Community containment measures—while designed to keep people safe—severely disrupted routine care and service delivery. Individuals with diabetes experienced difficulties accessing care providers, medications, and testing supplies. The pandemic has also led to psychosocial stress, such as feelings of powerlessness and a lack of social support. All of these disruptions can compromise optimal diabetes management and, consequently, increase the risk of negative short- and long-term outcomes.”

Presented at the Annual Meeting of the European Association for the Study of Diabetes, the current study was designed by Ratzki-Leewing and a team of colleagues with an interest in describing the effects of the COVID-19 pandemic on patients with diabetes. To do so, investigators designed their study as an analysis of data from the Sanofi Pasteur-sponsored iNPHORM (Investigating Novel Predictions of Hypoglycemia Occurrence in Real-world Models) study.

An observational study with more than 1200 patients created with the intent of testing an online question platform, iNPHORM collected data from monthly surveys disseminated over the course of a year. During the pandemic, 20 COVID-19 items were disseminated. Using this data, investigators hoped to develop a greater understanding of how COVID-19 might have impacted this cohort.

A sample of 772 respondents was included in the investigators’ analysis. Investigators pointed out 18.9% had type 1 diabetes, the mean age of the cohort was 52.1 (SD, 14.5) years as of January 2021, 51% were female, the median diabetes duration was 14 (IQR, 15) years, and 22.8% had an A1c greater than 8.1%. Among those included in the study, 9.3% had medically confirmed COVID-19 between March 20220 and January 2021.

Upon analysis, results suggested 24.7% of those with type 1 diabetes and 23.1% with type 2 diabetes reported the pandemic made affording rent or living expenses somewhat or much harder (P=.53). Investigators pointed out 18.8% (T1DM: 21.2%; T2DM: 18.3%; P=.14) reported increased difficulty keeping adequate food supply to avoid hypoglycemia and 22.2% reported increased difficulty in retrieving diabetes medications (T1DM: 24.0%; T2DM: 21.8%; P=.46).

Further analysis of survey responses indicated 17.4% (T1DM: 19.9%; T2DM: 16.8%; P=.16) reported increased difficulty affording their diabetes medications and 16.2% (T1DM: 17.1%; T2DM: 16.0%; P=.40) reported increased difficulty affording testing supplies. Additionally, 11.6% (T1DM: 8.2%; T2DM: 12.3%; P=.82) reported increased difficulty in remembering to take diabetes medications, 12.5% (T1DM: 9.6%; T2DM: 13.1%; P=.44) reported increased difficulty to remember to test glucose, and 12.5% (T1DM: 9.6%; T2DM: 13.1%; P=.42) reported increased difficulty to remember to monitor hypoglycemia.

Of note, greater than 1-in-10 (11.4%) felt less in control of their hypoglycemia (T1DM: 15.8%; T2DM: 10.4%; P=.01) and 16% reported insufficient social support to help manage events (T1DM: 15.8%; T2DM: 16.0%; P=.71). Investigators also pointed out greater than 1-in-4 respondents reported the pandemic made it more difficult to consult with diabetes care providers (T1DM: 26.0%; T2DM: 25.0%, P=.60).

“COVID-19 has caused devastating ripple effects that extend well-beyond infection alone. Not least are the impacts it has had on Americans with diabetes, of whom many are now struggling to maintain control of their disease. This is the first real-world study to quantify these diverse impacts in a general US population with T1D and T2D, and highlights the pressing care gaps caused by the pandemic. We hope our findings provide a roadmap for necessary remedial action that ensures undisrupted diabetes management moving forward. We mustn’t let these patients fall through the cracks.”

This study, “How COVID-19 has impacted diabetes management in the United States (iNPHORM study),” was presented at EASD 2021 and simultaneously published in Diabetologia.