Understanding impacts of COVID-19 restrictions on glycemic control for patients with diabetes in Japan

Kiyoko Uno-Eder; Noriko Satoh-Asahara; Manabu Hibiya; Kenji Uno; Takuya Uchino; Koji Morita; Toshio Ishikawa; Tetsuji Kaneko; Hajime Yamakage; Yuki Kitaoka; Tomohiro Sawa; Kazuhisa Tsukamoto; Tamio Teramoto

doi:10.1007/s40200-023-01302-5

Understanding impacts of COVID-19 restrictions on glycemic control for patients with diabetes in Japan

J Diabetes Metab Disord. 2023 Sep 21;22(2):1695-1703. doi: 10.1007/s40200-023-01302-5. eCollection 2023 Dec.

Authors

Affiliations

¹ Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
² Teikyo Academic Research Center, Teikyo University, Tokyo, Japan.
³ Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
⁴ Medical Informatics Department, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
⁵ Medical Information System Research Center, Teikyo University, Tokyo, Japan.

PMID: 37975143
PMCID: PMC10638246 (available on 2024-09-21)
DOI: 10.1007/s40200-023-01302-5

Abstract

Objective: This study evaluated the changes in the status of glycemic control and lipid management in patients with diabetes under COVID-19 containment restrictions, in order to better understand the impacts of events causing lifestyle restrictions. Patient characteristics with worsened glycemic control were also assessed.

Methods: We conducted a retrospective and observational cohort study using the electronic health records of 5,169 patients with diabetes seeking medical care in two healthcare centers. Laboratory test results including glycemic and lipid goal attainment rates were compared between pre-COVID-19 (January to December 2019) and the first wave of COVID-19 (February to June 2020). Multiple regression models were used to evaluate the association between glycated hemoglobin (HbA1c) at baseline and during the first wave with covariates such as concomitant medications and comorbidities.

Results: The HbA1c goal achievement rate improved significantly from 39.0% to 43.1% (p < 0.0001) overall, and more patients reached their glycemic target during COVID-19 restrictions. No significant changes were observed in lipid control. An indexed change in HbA1c level showed that glycemic control improved in 2,230 patients and worsened in 1,619 patients. Administration of insulin, GLP-1, and sulfonylureas were each identified as factors correlated with elevated HbA1c, during the first wave of COVID-19.

Conclusion: Although the glycemic control in patients with diabetes improved overall under COVID-19 restrictions, those on insulin, GLP-1, or sulfonylureas worsened. These findings suggest the need to better understand what drives differences in glycemic control to better support people with diabetes for future epidemiological outbreaks.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-023-01302-5.

Keywords: Atherosclerosis; COVID-19; Diabetes; Electronic Health Record; Glycemia.

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