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Impact of the UK COVID‐19 pandemic on HbA1c testing and its implications for diabetes diagnosis and management

Letter to the Editor Diabetes mellitus (DM) is a risk factor for poor outcome in patients with COVID‐19.1 However, the focus on mitigating the effects of SARS‐CoV‐2 has resulted in many routine healthcare services, including blood test monitoring in conditions such as DM, being disrupted. The testin...

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Bibliographic Details
Published in:International Journal of Clinical Practice 2021-04, Vol.75 (4), p.e13980-n/a
Main Authors: Holland, David, Heald, Adrian H., Stedman, Mike, Green, Lewis, Scargill, Jonathan, Duff, Christopher J., Hanna, Fahmy W.F., Wu, Pensee, Halsall, Ian, Gaskell, Neil, Fryer, Anthony A.
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Language:English
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Summary:Letter to the Editor Diabetes mellitus (DM) is a risk factor for poor outcome in patients with COVID‐19.1 However, the focus on mitigating the effects of SARS‐CoV‐2 has resulted in many routine healthcare services, including blood test monitoring in conditions such as DM, being disrupted. The testing delay in this group would, on average, result in a mean increase in HbA1c of 5.7 mmol/mol (95% confidence interval (CI) 5.2‐6.2mmol/mol) over and above that expected if monitoring were performed according to NICE guidance.2-4 This estimate is based on the analysis of 400 497 HbA1c tests in 79 409 individuals as previously described.4 We found in that analysis that testing outside guidance on HbA1c monitoring frequency, is associated with a significant detrimental effect on diabetes control. Extrapolating this to the UK population, these data equate to missed monitoring tests in 489 000 people with sub‐optimally‐controlled diabetes, leading to missed glycaemic control targets with associated increased risk of complications, including symptomatic cardiovascular disease and renal impairment, with their associated excess mortality risk.5 These data also equate to ~127 000 missed pre‐diabetes and 76 000 missed diabetes diagnoses, with consequent delay in lifestyle advice and treatment initialisation as advised by NICE.2, 4 We have previously shown that HbA1c testing at a 3 monthly interval was associated with a 3.8% reduction in HbA1c compared with a 1.5% increase observed with annual testing.
ISSN:1368-5031
1742-1241
DOI:10.1111/ijcp.13980