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Lehner CT, Eberl M, Donnachie E, Tanaka LF, Schauberger G, Schederecker F, Himmler S, Sundmacher L, Klug SJ. Incidence trend of type 2 diabetes from 2012 to 2021 in Germany: an analysis of health claims data of 11 million statutorily insured people. Diabetologia 2024; 67:1040-1050. [PMID: 38409438 PMCID: PMC11058936 DOI: 10.1007/s00125-024-06113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/17/2024] [Indexed: 02/28/2024]
Abstract
AIMS/HYPOTHESIS The aim of the study is to describe the time trend of type 2 diabetes incidence in the largest state of Germany, Bavaria, from 2012 to 2021, and to compare the incidence rates during the pandemic period (2020-2021) to the pre-pandemic period (2012-2019). METHODS This secondary data analysis uses health claims data provided by the Bavarian Association of Statutory Health Insurance Physicians (KVB), covering approximately 11 million insurees, accounting for 85% of the total population of Bavaria, Germany. Newly diagnosed type 2 diabetes cases in adults (≥20 years) coded as E11 (Diabetes mellitus, Type 2) or E14 (Unspecified diabetes mellitus) under ICD-10, German modification (ICD-10-GM) for the study period 2012 to 2021 were included. Annual and quarterly age-standardised incidence rates (ASIR) stratified by sex, age and region were calculated using the European standard population. Sex-specific crude incidence rates (CIR) were calculated using 10-year age groups. Regression analyses adjusted for time trends, seasonal effects, and pandemic effects were used to analyse the incidence trend and to assess the effect of the pandemic. RESULTS Overall, 745,861 new cases of type 2 diabetes were diagnosed between 2012 and 2021: 50.4% (376,193 cases) in women. The male/female ratio remained stable over the observation period, while the median age at diagnosis decreased from 61 to 58 years in men and from 66 years to 61 years in women. ASIR were consistently higher for men compared with women, with the yearly difference remaining stable over time (2012: 18%; 2021: 20%). An overall decreasing trend in ASIR was observed during the study period, with a strong decrease from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021 for both sexes. For men, ASIR decreased from 1514 per 100,000 person-years in 2012 to 995 per 100,000 person-years in 2021 (4.6% average annual reduction), and for women from 1238 per 100,000 person-years in 2012 to 796 per 100,000 person-years in 2021 (4.8% average annual reduction). This downward trend was also observed for age groups above 50 years. Regression analyses showed no significant change in incidence rates during the pandemic period (2020 and 2021) compared with the pre-pandemic period. CONCLUSIONS/INTERPRETATION For the first time, a 10-year incidence trend of type 2 diabetes is reported for Germany, showing a strong decline from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021. The incidence trend of type 2 diabetes appears not to have been affected by the first 2 years of the COVID-19 pandemic. Despite an overall increasing prevalence, the incidence is decreasing, potentially resulting from robust screening by family physicians, reducing the median age at diagnosis by 3 to 5 years. However, further investigation is needed to fully identify the reasons for the declining incidence trend. Continued incidence monitoring is necessary to identify the long-term trend and the potential effect of the pandemic on diagnoses of type 2 diabetes.
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Affiliation(s)
- Carolin T Lehner
- Chair of Epidemiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Marian Eberl
- Chair of Epidemiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ewan Donnachie
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Luana F Tanaka
- Chair of Epidemiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Florian Schederecker
- Chair of Epidemiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sebastian Himmler
- Chair of Health Economics, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, School of Medicine and Health, Technical University of Munich, Munich, Germany.
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Ahuja S, Sugandha S, Kumar R, Zaheer S, Singh M. Seasonal variation of HbA1c levels in diabetic and non-diabetic patients. Pract Lab Med 2024; 40:e00396. [PMID: 38711868 PMCID: PMC11070616 DOI: 10.1016/j.plabm.2024.e00396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024] Open
Abstract
Background Hemoglobin A1c (HbA1c) serves as a pivotal marker for long-term glycemic control. The Diabetes Control and Complications Trial (DCCT) established its relevance, yet gaps exist in understanding potential seasonal variations in HbA1c levels among diabetic patients. The study highlights the need to explore potential seasonal variations in HbA1c levels and their impact on diabetic patients. Materials and methods This is an observational study conducted in a tertiary care hospital from January to December 2019, the study analyzed HbA1c levels in 8138 patients. Blood samples were collected using Potassium EDTA-containing vials and processed with an automated analyzer. Seasonal variations were explored using time series analysis. Results Mean HbA1c levels peaked during the monsoon (June to September) and were lowest in autumn (October to November). Subgroup analysis revealed differences in patients with HbA1c values below and above 6.5 %. Those with controlled blood sugar showed higher levels in winter (December to February) and monsoon (June to September), while patients with HbA1c values ≥ 6.5 % exhibited significantly lower levels in monsoon (June to September) and autumn (October to November) compared to summer (March to May). Conclusion In contrast to global trends, Indian patients demonstrated distinct seasonal variations in HbA1c levels. The highest levels during the monsoon (June to September) may be linked to reduced outdoor activity and dietary changes. The study emphasizes the need for tailored diabetes management considering seasonal influences. Further extensive, longitudinal studies across diverse Indian regions are recommended to comprehensively grasp the impact of seasonal changes on diabetes outcomes.
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Affiliation(s)
- Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sugandha Sugandha
- Department of Pathology, GS Medical College and Hospital, Pilkhuwa, Hapur, Uttar Pradesh, India
| | - Rohit Kumar
- Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mukul Singh
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Gough A, Sitch A, Ferris E, Marshall T. Within-subject variation of HbA1c: A systematic review and meta-analysis. PLoS One 2023; 18:e0289085. [PMID: 37531355 PMCID: PMC10395823 DOI: 10.1371/journal.pone.0289085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Glycosylated haemoglobin (HbA1c) measurement is used to diagnose and to guide treatment of diabetes mellitus. Within-subject variability in measured HbA1c affects its clinical utility and interpretation, but no comprehensive systematic review has described within-subject variability. METHODS A systematic review and meta-analysis was performed of within-subject variability of HbA1c. Multiple databases were searched from inception to November 2022 for follow-up studies of any design in adults or children, with repeated measures of HbA1c or glycosylated haemoglobin. Title and abstract screening was performed in duplicate, full text screening and data extraction by one reviewer and verified by a second. Risk of bias of included papers was assessed using a modified consensus-based standards for the selection of health measurement Instruments (COSMIN) tool. Intraclass correlation coefficient (ICC) results were pooled with a meta-analysis and coefficient of variation (CV) results were described by median and range. RESULTS Of 2675 studies identified, 111 met the inclusion criteria. Twenty-five studies reported variability data in healthy patients, 19 in patients with type 1 diabetes and 59 in patients with type 2 diabetes. Median within-subject coefficient of variation (CV) was 0.070 (IQR 0.034 to .09). For healthy subjects the median CV for HbA1c % was 0.017 (IQR 0.013 to 0.022), for patients with type 1 diabetes 0.084 (IQR 0.067 to 0.89) and for type 2 diabetes 0.083 (IQR 0.06 to 0.10). CV increased with mean population HbA1c. LIMITATIONS Assessment of variability was not the main aim of many of the included studies and some relevant papers may have been missed. Many included papers had few participants or few repeated measurements. CONCLUSIONS Within-subject variability of HbA1c is higher for patients with than without diabetes and increases with mean population HbA1c. This may confound observed relationships between HbA1c variability and health outcomes. Because of its importance in clinical decision-making there is a need for better estimates and understanding of factors associated with of HbA1c variability.
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Affiliation(s)
- Alex Gough
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alice Sitch
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Erica Ferris
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom Marshall
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Xin L, Zhu Y, Zhao J, Fang Y, Xie J. Association between short-term exposure to extreme humidity and painful diabetic neuropathy: a case-crossover analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:13174-13184. [PMID: 36125681 DOI: 10.1007/s11356-022-23095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/14/2022] [Indexed: 06/15/2023]
Abstract
Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus, which reduces the quality of life. However, the association between PDN and environmental factors, especially ambient humidity, remains unclear. Therefore, this study investigated the impact of extreme humidity events on PDN. Data on PDN-related hospital admissions to two tertiary hospitals in Hefei, China (2014-2019) were obtained. A distributed lag non-linear model with a case-crossover design was used to quantitatively estimate the effects of ambient humidity on PDN, and the results were stratified by sex and age. The 1st, 10th, 90th, and 99th percentiles of relative humidity (RHU) were defined as extreme humidity, and the average relative humidity (74.94%) was set as the reference value. Non-linear exposure-response curves between the RHU and PDN cases were obtained. Extreme humidity (92%) had a significant effect on PDN with a relative risk (RR) of 1.13 (95% confidence interval (CI): 1.01-1.26) on a particular day, which increased with the RHU (RR: 1.21, 95% CI: 1.02-1.45 at 98% extreme humidity). Stratification analysis showed that women (RR: 1.38, 95% CI: 1.07-1.77) and patients aged < 65 years (RR: 1.26, 95% CI: 1.01-1.57) were highly susceptible to this effect on the same day. The results suggest that extreme humidity is a crucial trigger for PDN onset in diabetes patients. Furthermore, the effects vary with sex and age. This study provides detailed evidence of the adverse effects of extreme weather on diabetes patients.
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Affiliation(s)
- Ling Xin
- The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Mei Shan Road, Shushan District, Hefei, 230031, Anhui, People's Republic of China.
| | - Yongjian Zhu
- School of Management, University of Science and Technology of China, 96 Jin Zhai Road, Bao He District, Hefei, 230026, Anhui, People's Republic of China
| | - Jindong Zhao
- The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Mei Shan Road, Shushan District, Hefei, 230031, Anhui, People's Republic of China
| | - Yanyan Fang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Mei Shan Road, Shushan District, Hefei, 230031, Anhui, People's Republic of China
| | - Jingui Xie
- School of Management, Technical University of Munich, Bildungscampus 9, 74076, Heilbronn, Germany
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He MZ, Kloog I, Just AC, Gutiérrez-Avila I, Colicino E, Téllez-Rojo MM, Luisa Pizano-Zárate M, Tamayo-Ortiz M, Cantoral A, Soria-Contreras DC, Baccarelli AA, Wright RO, Yitshak-Sade M. Intermediate- and long-term associations between air pollution and ambient temperature and glycated hemoglobin levels in women of child bearing age. ENVIRONMENT INTERNATIONAL 2022; 165:107298. [PMID: 35597113 PMCID: PMC9233109 DOI: 10.1016/j.envint.2022.107298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Air pollution has been linked to obesity while higher ambient temperatures typically reduce metabolic demand in a compensatory manner. Both relationships may impact glucose metabolism, thus we examined the association between intermediate- and long-term exposure to fine particulate matter (PM2.5) and ambient temperature and glycated hemoglobin(HbA1c), a longer-term marker of glucose control. METHODS We assessed 3-month, 6-month, and 12-month average air pollution and ambient temperature at 1-km2 spatial resolution via satellite remote sensing models (2013-2019), and assessed HbA1c at four, six, and eight years postpartum in women enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort based in Mexico City. PM2.5 and ambient temperature were matched to participants' addresses and confirmed by GPS tracker. Using linear mixed-effects models, we examined the association between 3-month, 6-month, and 12-month average PM2.5 and ambient temperature with repeated log-transformed HbA1c values. All models included a random intercept for each woman and were adjusted for calendar year, season, and individual-level confounders (age, marital status, smoking, alcohol consumption level, and education level). RESULTS We analyzed 1,265 HbA1c measurements of 484 women. Per 1 µg/m3 increase in 3-month and 6-month PM2.5, HbA1c levels increased by 0.28% (95% confidence interval (95 %CI): 0.14, 0.42%) and 0.28% (95 %CI: 0.04, 0.52%) respectively. No association was seen for 12-month average PM2.5. Per 1 °C increase in ambient temperature, HbA1c levels decreased by 0.63% (95 %CI: -1.06, -0.21%) and 0.61% (95 %CI: -1.08, -0.13%), while the 12-month average again is not associated with HbA1c. CONCLUSIONS Intermediate-term exposure to PM2.5 and ambient temperature are associated with opposing changes in HbA1c levels, in this region of high PM2.5 and moderate temperature fluctuation. These effects, measurable in mid-adult life, may portend future risk of type 2 diabetes and possible heart disease.
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Affiliation(s)
- Mike Z He
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States.
| | - Itai Kloog
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Iván Gutiérrez-Avila
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - María Luisa Pizano-Zárate
- Nutrition and Bioprogramming Coordination, National Institute of Perinatology, Mexico City, Mexico; UMF 4, South Delegation of the Federal District, Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | | | - Diana C Soria-Contreras
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, United States
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
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Seasonal variations and the influence of COVID-19 pandemic on hemoglobin A1c, glycoalbumin, and low-density lipoprotein cholesterol. Diabetol Int 2022; 13:599-605. [PMID: 35281700 PMCID: PMC8902849 DOI: 10.1007/s13340-022-00574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/20/2022] [Indexed: 11/20/2022]
Abstract
Aim The purpose of the study was to investigate seasonal variations in HbA1c, GA and LDL-C and to examine the effects of the COVID-19 pandemic on these variations and on glycemic and lipid control themselves in patients with type 2 diabetes. Patients and methods The subjects were outpatients with type 2 diabetes who had received standard treatment for glycemic control for more than 3 years. Data for patients who visited our hospital from January 2021 to March 2021 were retrospectively investigated based on electronic medical records. Results HbA1c showed seasonal variation (high in winter–spring and low in summer–autumn), and this was similar during the COVID-19 pandemic. However, the mean HbA1c over 1 year was significantly elevated during the COVID-19 pandemic (7.53 ± 1.02% in 2020) compared with the previous 2 years: (7.34 ± 0.91 in 2018, 7.39 ± 0.93 in 2019; 2020 vs. 2018; 0.19%, P < 0.001; 2020 vs. 2019; 0.14%, P = 0.0013) and the difference was larger in winter. GA showed no apparent seasonal variation, but mean GA during the COVID-19 pandemic was elevated compared with earlier years (2020 vs. 2018, P < 0.001; 2020 vs. 2019, P < 0.001). LDL-C did not show apparent seasonal variation and was unaffected by COVID-19 pandemic. Conclusion The COVID-19 pandemic influenced mean HbA1c and GA levels over 1 year, but did not affect seasonal variations, while LDL-C was not affected by COVID-19. Observation of these levels over a longer period is warranted to determine the longer-term influence of the COVID-19 pandemic.
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Endo K, Miki T, Itoh T, Kubo H, Ito R, Ohno K, Hotta H, Kato N, Matsumoto T, Kitamura A, Tamayama M, Wataya T, Yamaya A, Ishikawa R, Ooiwa H. Impact of the COVID-19 Pandemic on Glycemic Control and Blood Pressure Control in Patients with Diabetes in Japan. Intern Med 2022; 61:37-48. [PMID: 34980759 PMCID: PMC8810256 DOI: 10.2169/internalmedicine.8041-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective In this study, we investigated whether and how the COVID-19 pandemic affected glycemic control and blood pressure (BP) control in patients with diabetes mellitus (DM). Methods DM patients whose HbA1c level was measured regularly before and after the declaration of a state of emergency were included in this study. Some patients were given questionnaires about changes in their lifestyle to determine the factors affecting glycemic control and BP control. Results The median HbA1c level of the 804 patients increased significantly from 6.8% before the state of emergency to 7.1% and 7.0% during and after the state of emergency, respectively. This was in contrast to the decrease one year earlier due to seasonal variations. In the 176 patients who responded to the questionnaire, the HbA1c level also increased significantly during and after the state of emergency. The worsening of glycemic control was more pronounced in the group that had achieved HbA1c of <7% before the state of emergency than in those with higher values. Unlike the rise in HbA1c, the BP did not rise during the state of emergency but did rise significantly afterwards. There was no marked decrease in HbA1c or BP after the state of emergency, even in patients who responded that they were much more careful with their diet, ate less, or exercised more. Conclusions The COVID-19 pandemic worsened glycemic control and BP control, even in patients who perceived no marked change in their diet or exercise, suggesting that more active lifestyle guidance is necessary for good treatment of DM patients.
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Affiliation(s)
- Keisuke Endo
- Department of Cardiology and Diabetes, Oji General Hospital, Japan
| | - Takayuki Miki
- Department of Cardiology and Diabetes, Oji General Hospital, Japan
| | - Takahito Itoh
- Department of Cardiology and Diabetes, Oji General Hospital, Japan
| | - Hirofumi Kubo
- Medical Record Administration Center, Oji General Hospital, Japan
| | - Ryosuke Ito
- Department of Cardiology and Diabetes, Oji General Hospital, Japan
| | - Kouhei Ohno
- Department of Cardiology and Diabetes, Oji General Hospital, Japan
| | - Hiroyuki Hotta
- Department of Cardiology and Diabetes, Oji General Hospital, Japan
| | - Nobuo Kato
- Department of Cardiology and Diabetes, Oji General Hospital, Japan
| | | | - Aya Kitamura
- Internal Medicine Outpatient Clinic, Oji General Hospital, Japan
| | - Mai Tamayama
- Internal Medicine Outpatient Clinic, Oji General Hospital, Japan
| | - Takako Wataya
- Internal Medicine Outpatient Clinic, Oji General Hospital, Japan
| | - Ayaka Yamaya
- Internal Medicine Outpatient Clinic, Oji General Hospital, Japan
| | - Rei Ishikawa
- Medical Record Administration Center, Oji General Hospital, Japan
| | - Hitoshi Ooiwa
- Department of Cardiology and Diabetes, Oji General Hospital, Japan
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Impact of SARS-CoV-2 Lockdown on Glycaemic Control: A Retrospective Observational Cohort Study in a Tertiary Setting. J Clin Med 2021; 10:jcm10184098. [PMID: 34575207 PMCID: PMC8466167 DOI: 10.3390/jcm10184098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/23/2022] Open
Abstract
We analysed the effects of Swiss national lockdown due to the COVID-19 pandemic on the glycaemic control in patients with diabetes mellitus. In a retrospective observational cohort study with observation period 16 December 2018–27 July 2020, we included tertiary care patients with diabetes and at least one glycated haemoglobin A1c (HbA1c) measurement before and after the lockdown beginning. Main outcome measure was change in HbA1c after the lockdown. We included 1078 patients (86% diabetes type 2) with a mean HbA1c of 55.63 mmol/mol (7.24%). Glycaemic control was susceptible to seasonal changes with higher mean HbA1c in winter as compared to spring (57.49 mmol/mol (7.41%) vs. 55.52 mmol/mol (7.23%), p = 0.013). The lockdown did not affect the mean HbA1c values of all patients. However, we found a higher proportion of type 2 diabetes patients with a worsening HbA1c after the lockdown as compared to the year before (32% vs. 22.9%, p = 0.02). In a mixed-model regression multivariable analysis, inappropriate alcohol intake and hypothyroidism were associated with an increase in HbA1c after the lockdown. In conclusion, the national lockdown had no effect on overall mean HbA1c values but affected a proportion of type 2 diabetes patients with worsening HbA1c, whose individual risk factors were identified.
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