Quality and Outcome of Diabetes Care During the COVID-19 Pandemic in a Primary Care Setting in Switzerland

Benjamin Sebastian Lüthi, Dr. Stefania Di Gangi, Laura Diaz Hernandez, Prof. Andreas Zeller, Dr. Stefan Zechmann, Dr. Roland Fischer

Keywords: diabetes mellitus, primary care, COVID-19 pandemic, quality indicators, diabetes outcomes

Background:
During the pandemic, not only SARS-CoV-2 infections and their complications have an impact on public health. The management of non-communicable diseases such as diabetes mellitus can be affected too. Patients may not receive the same quality of care because of pandemic.

Research questions:
To determine the impact of the pandemic on quality and outcome of diabetes care.

Method:
Retrospective comparison of two cohorts in a primary care setting in Switzerland. Adult patients (≥18 years) with a diagnosis of diabetes mellitus and with at least one consultation at a general practitioner, between 17.03.2018 and 16.03.2019 (cohort 1) and 17.03.2019 and 16.03.2020 (cohort 2), were included and observed for two years (until 16.03.2020 and 16.03.2021 respectively). Quality indicators and outcomes of diabetes care, at patient and practitioner level, were compared before and during the COVID-19 pandemic.

Results:
A total of 27,043 patients and 191 practices were included, 23,903 in cohort 1 and 25,092 in cohort 2. The fraction of patients lost to follow-up attributable to the pandemic was 28% [95% Confidence Interval: 25%, 30%]. At patient level, regular measurement of weight, Hemoglobin A1c (HbA1c), blood pressure and serum creatinine were less frequent during the pandemic. At practitioner level, less patients reached the target of an HbA1c value ≤ 7% and a blood pressure value of <140/90 mmHg during the pandemic. However, more patients had an LDL-cholesterol value of < 2.6 mmol/l. Although higher HbA1c values were observed in the months after lockdown, values converged to the same level, for both cohorts, by the end of follow-up period.

Conclusions:
A considerable drop of quality in diabetes mellitus care could be observed during the pandemic (17.03.2020 - 16.03.2021). However, HbA1c values converged to the same level for both cohorts at the end of the observation period. Thus, the long term effect on relevant outcomes has not yet been visible.

Points for discussion: