Impact of the COVID-19 Pandemic on Diabetes Care for Adults With Type 2 Diabetes in Ontario, Canada

• Published in: Canadian journal of diabetes 2022-10, Vol.46 (7), p.715-721
• Main Authors: Moin, John S., Troke, Natalie, Plumptre, Lesley, Anderson, Geoffrey M.
• Format: Article
• Language: English
• Subjects: Canada; COVID-19; diabetes; diabetes care; diabète; diabète de type 2; Ontario; Original Research; pandemic; pandémie; quality of care; qualité des soins; soins en diabète; type 2 diabetes
• ISSN: 1499-2671; 2352-3840; 2352-3840
• DOI: 10.1016/j.jcjd.2022.04.009

The COVID-19 pandemic and related public health prevention measures have led to a disruption of the delivery of routine care and may have had an impact on the quality of diabetes care. Our aim in this study was to evaluate the extent to which structure, process and outcome quality measures in diabetes care changed in the first 6 months of the pandemic compared with previous periods. A before-and-after observational study was conducted of all community-living Ontario residents >20 years of age and living with diabetes. The patients were divided into 3 cohorts: a pandemic cohort, alive March to September 2020 (n=1,393,404); reference cohort 1, alive March to September 2019 (n=1,415,490); and reference cohort 2, alive September 2019 to February 2020 (n=1,444,000). Outcome measures were in-person/virtual visits to general practitioners and specialists, eye examinations, glycated hemoglobin (A1C) and low-density lipoprotein (LDL) testing, filled prescriptions, and admissions to emergency departments (EDs) and hospitals for acute and chronic diabetes complications. The probability of an in-person visit to a general practitioner decreased by 47% (95% confidence interval [CI], 47% to 47%) in the pandemic period compared with both previous periods. The probability of having an eye exam was lower by 43% (95% CI, 44% to 43%), an A1C test by 28% (95% CI, 29% to 28%) and an LDL test by 31% (95% CI, 31% to 31%) in the pandemic period compared with the same 6-month period the year before. There were very small decreases in drug prescriptions and decreases of 18% and 16% in ED and hospital visits for complications. We observed disruptions to both structure and process measures of diabetes care in Ontario during the first wave of the pandemic. La pandémie de la COVID-19 et les mesures de prévention de la santé publique qui y sont associées ont causé des perturbations dans la prestation des soins courants et peuvent avoir eu des répercussions sur la qualité des soins en diabète. L’objectif de notre étude était d’évaluer jusqu’à quel point les mesures de la structure, des processus et de la qualité des résultats en matière de soins en diabète avaient changé dans les 6 premiers mois de la pandémie par rapport aux périodes précédentes. Nous avons évalué les études observationnelles avant-après de tous les résidents ontariens de > 20 ans et diabétiques qui vivent dans la communauté. Nous avons réparti les patients en 3 cohortes : la cohorte de pandémie, en vie de mars à septemb