TY - JOUR T1 - Indirect effects of the COVID-19 pandemic on people with type 2 diabetes: time to urgently move into a recovery phase JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2021-014079 SP - bmjqs-2021-014079 AU - Eszter P Vamos AU - Kamlesh Khunti Y1 - 2021/10/21 UR - http://qualitysafety.bmj.com/content/early/2021/10/21/bmjqs-2021-014079.abstract N2 - While the direct risks of the COVID-19 on people with type 2 diabetes (T2D) are well established,1 the indirect effects of the COVID-19 response on their management are less well understood. It is estimated that 4.7 million people have diabetes in the UK with T2D accounting for 90% of all diabetes cases, with primary care being at the forefront of delivering diabetes care.2 Besides the disproportionately high immediate direct effects of the COVID-19 pandemic on people with T2D, it has also exerted indirect effects through severe disruptions in the routine care of patients.3 During the first wave of the pandemic, efforts were directed away from prevention and treatment of long-term conditions, resulting in reduced access to primary care services, cancelled and postponed consultations and reduced community care. Furthermore, many patients avoided or delayed seeking medical attention for routine follow-up or non-COVID-19-related problems, due to fear of infection and/or to reduce strain on health services overwhelmed by COVID-19.4 5 As a group with elevated clinical risk, people with T2D were advised strict adherence to recommendations issued to the general public, while those at highest risk of adverse outcomes within this at-risk group were also advised to minimise face-to-face contact with others.6 7 Although the disruptions in service delivery generally affected care pathways for all long-term conditions, diabetes was one of the most affected long-term conditions.8In this issue of BMJ Quality and Safety, Carr and colleagues provide important data on the scale of interruptions in the routine management of patients with T2D in UK primary care before and after the first peak of the COVID-19 pandemic.9 This large cohort study of 161 181 patients with T2D assessed temporal changes in the rates of diabetes health checks (or ‘care processes’) recommended by the English National Institute … ER -