Changes in Prescribing of Psychotropic Medication in Primary Care through the COVID-19 Pandemic in England: A National Level Prospective Survey (preprint)

BackgroundThe COVID-19 pandemic globally impacted healthcare provision. Prescribing changes of common medications can be used as a marker for new diagnoses.AimTo describe how psychotropic prescribing in England was affected by the COVID-19 pandemic.MethodsPrimary Care Prescribing data for different classes of drug from March 2017 - February 2022 were considered. To capture the impact during periods of restricted access to health services for new diagnoses/existing conditions, repeat prescriptions/episodic prescribing were included with account taken of historical trend.The pre-pandemic prescriptions issued each month from March 2017 - February 2020 were linearly extrapolated forward to give an expected annual growth (EAG). The monthly average expected prescriptions for the pandemic period (March 2020–February 2022) were compared with this.ResultsPhysical health medications had lower monthly prescriptions during the pandemic with antibiotics down -12.2%(EAG -1.4%). Most repeat prescriptions were for bronchodilators -1.8%(EAG 0%), hypertension and heart failure -1.3%(EAG 1%), and lipid regulating drugs at -0.1%(EAG 2.3%). Mental Health monthly prescribing increased with hypnotics/anxiolytics by 0.6%(EAG -2.4%), antipsychotics by 0.5%(EAG 2.7%) and antidepressants by 0.3% (EAG 4.9%) The three main antidepressant were: Sertraline grew by 21% so its share of total anti-depressants increased from 22.7% to 24.6% (+8%), Mirtazapine grew by 16% so share increased from 13.0% to 13.6% (+5%), Venlafaxine grew by 11% so share stayed at 6.3%(0%).ConclusionThe increase in anxiolytic/hypnotic prescribing above trend links to pandemic effects on anxiety/worry. The slight increase in antipsychotic prescribing may relate to antipsychotic use in care homes.

Analysis of continuous glucose tracking data in people with Type 1 Diabetes (T1DM) after Covid-19 Vaccination reveals unexpected link between immune and metabolic response, augmented by adjunctive oral medication (preprint)

Introduction: The COVID-19 vaccination programme is under way. Anecdotal evidence is increasing that some people with Type 1 Diabetes Mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before and after vaccination. Methods We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle® Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage(%) BG readings in the designated target range 3.9-10mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1). Results There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ±se 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ±se 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1-13.9%/ ≥14%. There was no significant change in BG variability in the 7days post COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age <53 vs ≥53 years (greater reduction in %BG in target for older individuals (-18% vs -9%)). Conclusion In T1DM, we have shown that COVID-19 vaccination can cause temporary perturbation of BG, with this effect more pronounced in patients talking oral hypoglycaemic medication plus insulin, and in older individuals. This may have consequences for patients with T2DM who are currently not supported by flash glucose monitoring.

How fast should social restrictions be eased in England as COVID-19 vaccinations are rolled out? (preprint)

Vaccination against the COVID-19 virus began in December 2020 in the UK and is now running at 5% population/week. High Levels of social restrictions were implemented for the third time in January 2021 to control the second wave and resulting increases in hospitalisations and deaths. Easing those restrictions must balance multiple challenging priorities, weighing the risk of more deaths and hospitalisations against damage done to mental health, incomes and standards of living, education outcomes and provision of non-Covid-19 healthcare. Weekly and monthly officially published values in 2020/21 were used to estimate the impact of seasonality and social restrictions on the spread of COVID-19 by age group, on the economy and healthcare services. These factors were combined with the estimated impact of vaccinations and immunity from past infections into a model that retrospectively reflected the actual numbers of reported deaths closely both in 2020 and early 2021. It was applied prospectively to the next 6 months to evaluate the impact of different speeds of easing social restrictions. The results show vaccinations are significantly reducing the number of hospitalisations and deaths. The central estimate is that relative to a rapid easing, the avoided loss of 57,000 life years from a strategy of relatively slow easing over the next 4 months comes at a cost in terms of GDP reduction of around £0.4 million/life-year loss avoided. This is over 10 times higher than the usual limit the NHS uses for spending against Quality Adjusted Life Years (QALYs) saved. Alternative assumptions for key factors affecting give significantly different trade-offs between costs and benefits of different speeds of easing. Disruption of non-Covid-19 Healthcare provision also increases in times of higher levels of social restrictions. In most cases, the results favour a somewhat faster easing of restrictions in England than current policy implies.

Age of people with Type 2 diabetes and the risk of dying following SARS-CoV-2 infection (preprint)

Our analysis as described in this research letter highlights the fact that age outweighs many other factors in people with T2DM in relation to mortality from SARS-CoV-2 virus, once infected. This fact should be taken into account in relation to the vaccination programme against coronavirus-19 in people with T2DM in the UK and elsewhere.

Impact of the UK COVID-19 pandemic on HbA1c testing and its implications for diabetes diagnosis and management (preprint)

Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.