Multicenter Study of the Impact of COVID-19 in Type 2 Diabetes Quality Management.

Background: Epidemics and pandemics have been shown to have widespread effects on health systems. Diabetes is a condition of particular risk during national emergencies such as the COVID-19 pandemic. The aim of this study is to determine the influence of COVID-19 in the patient's diabetes quality management.

Methods: We conducted a retrospective multicenter cohort study. Data from type 2 diabetes patients living in Sevilla were included into the study. The study was divided into two observation periods, before and during COVID-19. Metabolic status was assessed using the levels of hemoglobin A1c (A1C) measured during the pre- and CO-VID-19 period. The time interval between sequential A1C tests were also measured. We as well identified the loca-tions where the burden of diabetes quality management is clustered and their relation with demographic and economic factors.

Results: We included a total of 106,336 patients from four different hospitals. A significant number patients have worsened their quality management during COVID-19. During the first year of the pandemic, 72,235 patients did not have any hemoglobin A1c (A1C) control. By the time of data extraction, the time between A1C controls was significantly increased by 309 days (from 211 to 520). In addition, 34,001 patients who had A1C control during the COVID-19 period did not reveal a deterioration of their metabolic status. They showed a small but significant metabolic improvement indicated by reduced A1C levels from 52 mmol/mol to 51 mmol/mol. Just like the other group, these patients showed a significant increase of 29 days (from 195 to 224) between A1C controls. COVID-19 increased the substantial clustering for diabetes quality management in specific locations, mostly along the rural southeastern area of Sevilla and these variations were associated with economic and socio-demographic variants.

Conclusions: Our study highlighted the great impact of the COVID-19 in diabetes quality management exacerbating the previous inequities and disparities. Our results highlight the need for urgent patient intervention in the areas with high burdens of poorer quality management.