Increased non-COVID-related death among people with diabetes during the COVID pandemic

Recurrent lockdowns and public health measures throughout the COVID-19 pandemic have restricted access to routine diabetes care, routine follow-ups and access to medications. These disruptions have resulted in adverse diabetes outcomes, but the true effects of the COVID-19 pandemic on long-term outcomes and mortality in people with diabetes are still unclear. A recent international study¹ commissioned by the World Health organization aimed to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. This was a systematic review of the available literature and included 138 studies (n > 1 000 000 people). All studies compared pre-pandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). One study found that, in 2021, there was an 11% rise in non-COVID-related deaths among people with diabetes compared with 2019.

In children and adolescents, most studies showed increases in diabetic ketoacidosis frequency or severity, some due to new-onset diabetes (69 studies). While there was a decrease in hospital admissions in adults, increases in diabetes-related admissions to paediatric intensive care units were reported (35 studies). The latter seemed to be very consistent across countries. No significant impact was noted for diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies) and overall amputation rates (20 studies). No studies investigated renal failure. The adverse impact appeared to be most pronounced for females, younger people and racial and ethnic minority groups. Findings from this study highlight the need to have a flexible and adaptable health care system to ensure maintenance of good clinical outcomes from people living with chronic disease like diabetes in the face of future epidemics. Recognizing and addressing disparities and inequalities in healthcare are crucial.