Associations between attainment of incentivised primary care indicators and incident diabetic retinopathy in England: a population-based historical cohort study

Indirect effects of the COVID-19 pandemic on diagnosing, monitoring, and prescribing in people with diabetes and strategies for diabetes service recovery internationally

The COVID-19 pandemic has caused major disruptions in clinical services for people with chronic long-term conditions. In this narrative review, we assess the indirect impacts of the COVID-19 pandemic on diabetes services globally and the resulting adverse effects on rates of diagnosing, monitoring, and prescribing in people with type 2 diabetes. We summarise potential practical approaches that could address these issues and improve clinical services and outcomes for people living with diabetes during the recovery phase of the pandemic.

Routine care for people with newly diagnosed type 2 diabetes before and during the SARS-CoV-2 pandemic - results from the German Disease Analyzer database

AIM

To investigate whether the SARS-CoV-2 pandemic affected care for people with newly diagnosed type 2 diabetes in Germany.

METHODS

The Disease Analyzer database (IQVIA, Germany) contains routine data on diagnoses and treatments (ICD-10 and ATC codes) from patients followed in selected physician practices across Germany. We compared 21,747 individuals with a first diagnosis of type 2 diabetes between January 2018 and September 2019 with 20,513 individuals with a first diabetes diagnosis between March 2020 and November 2021.

RESULTS

In March and April 2020, the number of new diagnoses of diabetes decreased by 18.3% and 35.7%, respectively, compared to March and April of the previous two years. The previous diabetes incidence level was reached again in June 2020. Mean pre-treatment glucose levels were higher during the pandemic than before (fasting plasma glucose: +6.3 mg/dl (95% confidence interval: 4.6-8.0)). In the first six months after diabetes diagnosis, the mean number of GP visits, specialist referrals and HbA1c measurements decreased.

CONCLUSION

We observed a decrease in diabetes incidence in the early phase of the pandemic and slightly higher pretreatment blood glucose levels during the pandemic than before. Care for newly diagnosed diabetes was slightly worse during the pandemic than before.

Impact of diabetes on emergency care of acute myocardial infarction patients during the coronavirus disease 2019 pandemic: a nationwide population-based study

Background

Although acute myocardial infarction (AMI) requires timely intervention, limited nationwide data is available regarding the association between disruption of emergency services and outcomes of patients with AMI during the coronavirus disease 2019 (COVID-19) pandemic. Moreover, whether diabetes mellitus (DM) adversely affects disease severity in these patients has not yet been investigated.

Methods

This nationwide population-based study analyzed 45,648 patients with AMI, using data from the national registry of emergency departments (ED) in Korea. Frequency of ED visits and disease severity were compared between the COVID-19 outbreak period (year 2020) and the control period (the previous year 2019).

Results

The number of ED visits by patients with AMI decreased during the first, second, and third waves of the outbreak period compared to the corresponding time period in the control period (all p-values < 0.05). A longer duration from symptom onset to ED visit (p = 0.001) and ED stay (p = 0.001) and higher rates of resuscitation, ventilation care, and extracorporeal membrane oxygen insertion were observed during the outbreak period than during the control period (all p-values < 0.05). These findings were exacerbated in patients with comorbid DM; Compared to patients without DM, patients with DM demonstrated delayed ED visits, longer ED stays, more intensive care unit admissions (p < 0.001), longer hospitalizations (p < 0.001), and higher rates of resuscitation, intubation, and hemodialysis (all p-values < 0.05) during the outbreak period. While in-hospital mortality was similar in AMI patients with and without comorbid DM during the two periods (4.3 vs. 4.4%; p = 0.671), patients with DM who had other comorbidities such as chronic kidney disease or heart failure or were aged ≥ 80 years had higher in-hospital mortality compared with those without any of the comorbidities (3.1 vs. 6.0%; p < 0.001).

Conclusion

During the pandemic, the number of patients with AMI presenting to the ED decreased compared with that of the previous year, while the disease severity increased, particularly in patients with comorbid DM.

The impact of the COVID-19 pandemic on diabetes services: planning for a global recovery

The COVID-19 pandemic has disproportionately affected certain groups, such as older people (ie, >65 years), minority ethnic populations, and people with specific chronic conditions including diabetes, cardiovascular disease, kidney disease, and some respiratory diseases. There is now evidence of not only direct but also indirect adverse effects of COVID-19 in people with diabetes. Recurrent lockdowns and public health measures throughout the pandemic have restricted access to routine diabetes care, limiting new diagnoses, and affecting self-management, routine follow-ups, and access to medications, as well as affecting lifestyle behaviours and emotional wellbeing globally. Pre-pandemic studies have shown that short-term delays in delivery of routine care, even by 12 months, are associated with adverse effects on risk factor control and worse microvascular, macrovascular, and mortality outcomes in people with diabetes. Disruptions within the short-to-medium term due to natural disasters also result in worse diabetes outcomes. However, the true magnitude of the indirect effects of the COVID-19 pandemic on long-term outcomes and mortality in people with diabetes is still unclear. Disasters tend to exacerbate existing health disparities; as we recover ambulatory diabetes services in the aftermath of the pandemic, there is an opportunity to prioritise those with the greatest need, and to target resources and interventions aimed at improving outcomes and reducing inequality.

Study on BCVA, CMT, CME, Curative Effect, and Prognostic Value of DR Sufferers Based on Surgical Therapy Combined with VEGF Therapy at Different Times

In order to explore the efficacy and prognostic value of best corrected visual acuity (BCVA), central macular retinal thickness (CMT), and cystoid macular edema (CME) in diabetic retinopathy (DR) sufferers based on surgical therapy combined with vascular endothelial growth factor (VEGF) therapy at different times, a total of 170 cases of DR sufferers who visited our hospital from March 2019 to March 2021 are analyzed. All patients are randomly divided into control group and study group, with 85 cases and 85 eyes in each group. In addition, the contrast set received 2 therapies for 1.5 months/time, and the study set received 3 therapies for 1 month/time. The experimental results show that the BCVA of the two sets is notoriously enhanced. Besides, CMT and CME in the study set decrease more than those in the contrast set, and the blood vessel density of retinal capillaries in the contrast set and the examination set is notoriously enhanced. For DR sufferers, 1 month/time of anti-VEGF therapy can effectively enhance the sufferers’ visual acuity, CMT and CME. It is suggested that the clinical application of 1 month/time of anti-VEGF to DR sufferers can enhance the clinical therapeutic effect of sufferers and reduce the prognosis and recurrence.

Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study

There is little data on ethnic differences in incidence of DR and sight threatening DR (STDR) in the United Kingdom. We aimed to determine ethnic differences in the development of DR and STDR and to identify risk factors of DR and STDR in people with incident or prevalent type II diabetes (T2DM). We used electronic primary care medical records of people registered with 134 general practices in East London during the period from January 2007-January 2017. There were 58,216 people with T2DM eligible to be included in the study. Among people with newly diagnosed T2DM, Indian, Pakistani and African ethnic groups showed an increased risk of DR with Africans having highest risk of STDR compared to White ethnic groups (HR: 1.36 95% CI 1.02-1.83). Among those with prevalent T2DM, Indian, Pakistani, Bangladeshi and Caribbean ethnic groups showed increased risk of DR and STDR with Indian having the highest risk of any DR (HR: 1.24 95% CI 1.16-1.32) and STDR (HR: 1.38 95% CI 1.17-1.63) compared with Whites after adjusting for all covariates considered. It is important to optimise prevention, screening and treatment options in these ethnic minority groups to avoid health inequalities in diabetes eye care.