For people with diabetes, disruption from the COVID-19 pandemic led to higher rates of death and other adverse outcomes, particularly diabetic ketoacidosis (DKA) in children, new research found.
The data came from what was believed to be the first systematic review of evidence related to the clinical impact of the disruptions caused by the COVID-19 pandemic and delays in seeking care among people with diabetes, rather than illness from the virus itself. The review was commissioned by the World Health Organization (WHO) and included a total of 138 studies. The majority (39 each) were from North America and Western Europe, but some were from Eastern Europe, Asia, South America, Australia, and Egypt.
Despite a great deal of heterogeneity across the studies, there were some consistent patterns. Both all-cause and diabetes-related mortality were consistently increased during, compared to prior to, the pandemic, and most studies showed increases in major amputations and sight loss.
The findings were published on January 23, 2024, in The Lancet Diabetes & Endocrinology by Jamie Hartmann-Boyce, PhD, of the Department of Health Promotion and Policy at the University of Massachusetts Amherst, and colleagues. The same team had conducted a previous similar WHO-commissioned review of the effects of the SARS-CoV-2 virus itself on people with diabetes.
The findings hold lessons for future pandemics or other types of emergency situations, Hartmann-Boyle told Medscape Medical News. She cautioned that although the data came from around the world, most of the studies were done in higher-income areas. “There’s an inherent bias. These are people with access to healthcare. Our review is of evidence available globally, but the reality is that certain countries produce a lot more data than others.”
Several studies reported that people with type 1 diabetes with access to continuous glucose monitoring were likely to do well, or have even better A1c levels, during pandemic lockdown, whereas the opposite was true for those who didn’t. “We saw that technology really came in handy and helped a lot of people, but that can deepen already-existing inequalities,” she noted.
Of six studies examining all-cause mortality among people with diabetes during the pandemic, just one excluded deaths due to COVID-19. It reported an 11% rise in non-COVID deaths from 2019 to 2021, even after adjusting for various factors. Mortality rates were notably higher for those lacking care processes amid the pandemic.
