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Abstract
Objective To compare rates of performing National Institute for Health and Care Excellence-recommended health checks and prescribing in people with type 2 diabetes (T2D), before and after the first COVID-19 peak in March 2020, and to assess whether trends varied by age, sex, ethnicity and deprivation.
Methods We studied 618 161 people with T2D followed between March and December 2020 from 1744 UK general practices registered with the Clinical Practice Research Datalink. We focused on six health checks: haemoglobin A1c, serum creatinine, cholesterol, urinary albumin excretion, blood pressure and body mass index assessment. Regression models compared observed rates in April 2020 and between March and December 2020 with trend-adjusted expected rates derived from 10-year historical data.
Results In April 2020, in English practices, rates of performing health checks were reduced by 76%–88% when compared with 10-year historical trends, with older people from deprived areas experiencing the greatest reductions. Between May and December 2020, the reduced rates recovered gradually but overall remained 28%–47% lower, with similar findings in other UK nations. Extrapolated to the UK population, there were ~7.4 million fewer care processes undertaken March–December 2020. In England, rates for new medication fell during April with reductions varying from 10% (95% CI: 4% to 16%) for antiplatelet agents to 60% (95% CI: 58% to 62%) for antidiabetic medications. Overall, between March and December 2020, the rate of prescribing new diabetes medications fell by 19% (95% CI: 15% to 22%) and new antihypertensive medication prescribing fell by 22% (95% CI: 18% to 26%), but prescribing of new lipid-lowering or antiplatelet therapy was unchanged. Similar trends were observed across the UK, except for a reduction in new lipid-lowering therapy prescribing in the other UK nations (reduction: 16% (95% CI: 10% to 21%)). Extrapolated to the UK population, between March and December 2020, there were ~31 800 fewer people with T2D prescribed a new type of diabetes medication and ~14 600 fewer prescribed a new type of antihypertensive medication.
Conclusions Over the coming months, healthcare services will need to manage this backlog of testing and prescribing. We recommend effective communications to ensure patient engagement with diabetes services, monitoring and opportunities for prescribing, and when appropriate use of home monitoring, remote consultations and other innovations in care.
- COVID-19
- diabetes mellitus
- primary care
- health services research
Data availability statement
Data may be obtained from a third party and are not publicly available. Electronic health records are, by definition, considered “sensitive” data in the UK by the Data Protection Act and cannot be shared via public deposition because of information governance restriction in place to protect patient confidentiality. Access to data are available only once approval has been obtained through the individual constituent entities controlling access to the data. The primary care data can be requested via application to the Clinical Practice Research Datalink (www.cprd.com).
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Electronic health records are, by definition, considered “sensitive” data in the UK by the Data Protection Act and cannot be shared via public deposition because of information governance restriction in place to protect patient confidentiality. Access to data are available only once approval has been obtained through the individual constituent entities controlling access to the data. The primary care data can be requested via application to the Clinical Practice Research Datalink (www.cprd.com).
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Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
MJC and AKW are joint first authors.
DMA and MKR are joint senior authors.
Twitter @PharmacyDUPP, meds_safety, PSTRC_GM, @_AlisonWright, @RutterMK
Contributors DMA conceived the original idea. MKR, MJC and AKW helped develop the idea. MJC and AKW performed the analysis and verified the analytical methods. MKR and DMA also reviewed the clinical code sets. NK and NM (primary care clinicians), and LL and HT (secondary care diabetes clinicians) helped interpret the results. MKR wrote the manuscript with input from all authors. All authors critically reviewed and approved the final version.The lead authors (MJC and AKW: the manuscript’s guarantors) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. The corresponding author had full access to all of the data and the final responsibility to submit for publication.
Funding This work is funded by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).
Disclaimer The funding source had no role in the study design, data collection, data analysis, data interpretation or writing of the report. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests DMA reports research funding from AbbVie, Almirall, Celgene, Eli Lilly, Novartis, Janssen, UCB and the Leo Foundation outside the submitted work. MKR has received consulting fees and non-promotional lecture fees from Novo Nordisk in relation to cardiovascular disease and diabetes. The company has had no role in influencing the proposed study and is not expected to benefit from this work. Outside the submitted work, MKR reports receiving research funding from Novo Nordisk, consultancy fees from Novo Nordisk and Roche Diabetes Care, and modest owning of shares in GlaxoSmithKline. NM reports honorarium for presentations from Napp Pharmaceuticals, Novo Nordisk, Sanofi, MyLan, Boehringer Ingelheim, Lilly Diabetes, Abbott, Omnia-Med, Takeda UK and AstraZeneca. All other authors declare no competing interests.
Provenance and peer review Commissioned; internally peer reviewed.
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