scholarly journals Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes: a UK-wide cohort study involving 618,161 people in primary care

2021 ◽  
Author(s):  
Matthew J. Carr ◽  
Alison K. Wright ◽  
Lalantha Leelarathna ◽  
Hood Thabit ◽  
Nicola Milne ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Home Monitoring ◽  
Healthcare Services ◽  
Lipid Lowering ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Lipid Lowering Therapy ◽  
Historical Trends ◽  
Health Checks

AbstractOBJECTIVETo compare rates of performing NICE-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 and deprivation.METHODSWe constructed a cohort of 618,161 people with T2D followed between March and December 2020 from 1744 UK general practices registered with the Clinical Practice Research Datalink (CPRD; Aurum and GOLD databases). We focused on the following six health checks and prescribing: HbA1c, serum creatinine, cholesterol, urinary albumin excretion, blood pressure and BMI assessment, comparing trends using regression models and 10-year historical data.RESULTSIn April 2020, in English practices, rates of performing health checks were reduced by 76-88% when compared to 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% and 47% lower compared to historical trends, with similar findings in other UK nations. In England, rates of prescribing of new medication fell during April with reductions varying from 10% (4-16%) for antiplatelet agents to 60% (58-62%) for antidiabetic medications. Overall, between March and December 2020, the overall rate of prescribing new diabetes medications was reduced by 19% (15-22%) and new antihypertensive medication by 22% (18-26%). Similar trends were observed in other UK nations, except for a reduction in new lipid-lowering therapy prescribing March to December 2020 (reduction: 16% (10-21%)).CONCLUSIONSOver the coming months, healthcare services will need to manage this backlog of testing and prescribing. Effective communications should ensure that patients remain engaged with diabetes services, monitoring and opportunities for prescribing, and make use of home monitoring and remote consultations.

scholarly journals Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes: a UK-wide cohort study involving 618 161 people in primary care

2021 ◽  
pp. bmjqs-2021-013613
Author(s):  
Matthew J Carr ◽  
Alison K Wright ◽  
Lalantha Leelarathna ◽  
Hood Thabit ◽  
Nicola Milne ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Antihypertensive Medication ◽  
Lipid Lowering ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Lipid Lowering Therapy ◽  
Health Checks ◽  
New Type ◽  
The Uk

ObjectiveTo 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.MethodsWe 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.ResultsIn 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.ConclusionsOver 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.

scholarly journals Impact of COVID-19 on the diagnoses, HbA1c monitoring and mortality in people with type 2 diabetes: a UK-wide cohort study involving 13 million people in primary care

2020 ◽  
Author(s):  
Matthew J. Carr ◽  
Alison K. Wright ◽  
Lalantha Leelarathna ◽  
Hood Thabit ◽  
Nicola Milne ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Northern Ireland ◽  
Older People ◽  
Healthcare Services ◽  
Research Centre ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Before And After ◽  
The Uk

SUMMARYBackgroundThe COVID-19 pandemic has already disproportionately impacted people with diabetes. Timely diagnosis and appropriate monitoring in people with type 2 diabetes (T2D) are necessary to reduce the risk of long-term complications.MethodsWe constructed a cohort of 23M patients using electronic health records from 1709 UK general practices registered with the Clinical Practice Research Datalink (CPRD), including 13M patients followed between March and July 2020. We compared trends in diagnoses, monitoring and mortality in T2D, before and after the first COVID-19 peak, using regression models and 10-year historical data. We extrapolated the number of missed or delayed diagnoses using UK Office for National Statistics data.FindingsIn England, rates of new T2D diagnoses were reduced by 70% (95% CI 68%-71%) in April 2020, with similar reductions in Northern Ireland, Scotland and Wales. Between March and July, we estimated that there were more than 45,000 missed or delayed T2D diagnoses across the UK. In April, rates of HbA1c testing in T2D were greatly reduced in England (reduction: 77% (95% CI 76%-78%)) with more marked reductions in Northern Ireland, Scotland and Wales (reduction: 84% (83-84%)). Reduced rates of diagnosing and HbA1c monitoring were particularly evident in older people, in males, and in those from deprived areas. Mortality rates in T2D in England were more than 2-fold higher (110%) in April compared to prior trends, but were only 66% higher in Northern Ireland, Scotland and Wales.InterpretationAs engagement with the NHS increases, healthcare services will need to manage the backlog and the expected increase in T2D severity due to delayed diagnoses and reduced monitoring. Older people, men, and those from deprived backgrounds with T2D may be groups to target for early intervention.FundingNational Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre

scholarly journals Cohort profile for the MASTERMIND study: using the Clinical Practice Research Datalink (CPRD) to investigate stratification of response to treatment in patients with type 2 diabetes

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017989 ◽  
Author(s):  
Lauren R Rodgers ◽  
Michael N Weedon ◽  
William E Henley ◽  
Andrew T Hattersley ◽  
Beverley M Shields
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Practice ◽  
Treatment Response ◽  
Response To Treatment ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Data Quality Control ◽  
Data Set ◽  
The Impact

PurposeThis is a retrospective cohort study using observational data from anonymised primary care records. We identify and extract all patients with type 2 diabetes and associated clinical data from the Clinical Practice Research Datalink (CPRD) to inform models of disease progression and stratification of treatment.ParticipantsData were extracted from CPRD on 8 August 2016. The initial data set contained all patients (n=313 485) in the database who had received a type 2 diabetes medication. Criteria were applied to identify and exclude those with type 1 diabetes, polycystic ovarian syndrome or other forms of diabetes (n=40 204), and for data quality control (n=12). We identified 251 338 patients for inclusion in future analyses of diabetes progression and treatment response.Findings to dateFor 6-month response to treatment, measured by change in glycated haemoglobin (HbA1c), we have 91 765 patients with 119 785 treatment response episodes. The greatest impact on reduction of HbA1c occurs with first-line and second-line treatments, metformin and sulfonylurea. Patients moving to third-line treatments tend to have greater weights and higher body mass index. We have investigated the impact of non-adherence to commonly used glucose-lowering medications on HbA1c. For baseline-adjusted HbA1c change over 1 year, non-adherent patients had lower HbA1c reductions than adherent patients, with mean and 95% CI of −4.4 (−4.7 to −4.0) mmol/mol (−0.40 (−0.43 to −0.37) %).Future plansFindings from studies using these data will help inform future treatment plans and guidelines. Additional data are added with updates from CPRD. This will increase the numbers of patients on newer medications and add more data on those already receiving treatment. There are several ongoing studies investigating different hypotheses regarding differential response to treatment and progression of diabetes. For side effects, links to Hospital Episode Statistics data, where severe events such as hypoglycaemia will be recorded, will also be explored.

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