Impact of COVID-19 pandemic on HbA1c management and results in pediatric and adult outpatients with diabetes.

Abstract

Objectives: Diabetes mellitus intensify the risks and complications related to COVID-19 infection. A major effect of the pandemic has been a drastic reduction of in-person visits. The aim of this study was to evaluate the impact of the COVID-19 pandemic on HbA_1c management and results among pediatric and adult outpatients with diabetes, considering the laboratory and point-of-care testing (POCT) HbA_1c measurements.

Methods: Observational retrospective study including patients from pediatric and adult diabetes units was conducted. HbA_1c results obtained in the laboratory and POCT over 3 years (2019-2021) were collected from the laboratory information system.

Results: After the lockdown, the number of HbA_1c plummeted. Children returned soon to routine clinical practice. The number of HbA_1c increased gradually in adults, especially in POCT. Globally, HbA_1c results were lower in children compared with adults (p<0.001). HbA_1c values in children (p<0.001) and adults (p=0.002) decreased between pre-pandemic and post-pandemic periods, though lower than the HbA_1c reference change value. The percentage of HbA_1c results above 8% remained stable during the study period.

Conclusions: Continuous glucose monitoring and a telemedicine have been crucial, even allowing for improvements in HbA_1c results. During the lockdown, patients with better metabolic control were managed in the laboratory whereas patients with poorer control or a severe clinical situation were attended in diabetes units by POCT. Adults returned to pre-pandemic management slowly because they were more susceptible to morbidity and mortality due to COVID-19. Coordination among all health professionals has been essential to offering the best management, especially in difficult scenarios such as the COVID-19 pandemic.