The Lockdown Effect, A1C and Diabetes (LEAD) control audit/study: East London single centre experience

ABSTRACT

Background: The COVID-19 pandemic resulted in national international implementation of changes to the daily life of individuals. These changes included lockdown and social distancing. During COVID-19 pandemic. During COVID-19,doctors and nurses and other allied healthcare professionals were redeployed to the front line to manage patients presenting with COVID-19 in acute setting. Healthcare providers from different institutions had to adapt to the way of supporting and managing patients with different chronic conditions including diabetes. The implementation of lockdown affected diabetes care (Bonora et al 2020). COVID-19 pandemic enabled healthcare professionals to apply innovation including telemedicine/telephone clinics to manage diabetes patients and other patients needing outpatient follow up. Aim: To assess the effect of lockdown on diabetes control among diabetes patients in East London-Single centre experience. Method: Retrospective cohort study identified patients who were reviewed in the diabetes clinic before and after the pandemic and the A1C levels before December 2019 and in 2021.The data was obtained from clinic letters and clinic notes Demographic data were obtained including type of diabetes mellitus, gender, age. Outcomes assessed were change in HbA1C (worsening or improvement), if the patients had diabetes review during the pandemic (telemedicine) and whether HbA1C blood tests were done. Results: In total the results of HbA1C of 101 patients were identified.46 were females, 55 were males. The patients were aged between 17-to 89 years, mean age 56 years. There was improvement in HbA1c in 26 patients (26%) (despite pandemic and lockdown), and there was deterioration of HbA1c in (74 patient) 74% of all patients. 34 (34%) Patients were type 1 diabetes 61 patients (60%) were type 2 diabetes. 6 patients (6%) were Late Onset Diabetes of Adults (LADA). Discussion: In UK the first lockdown measure prevented spread of prevent spread of COVID-19 was introduced in March 2020.This resulted in disruption of patient‘s care especially those with chronic condition including diabetes. The worsening of diabetes control in these patients is explained by lack of exercise, weight gain and poor diet (Pal et al 2020) and probably poor compliance (Ghosal et al 2020). The patients in this study reported anxiety and stress due uncertainty of COVID-19 pandemic and probably this contributed to worsening HbA1C. HbA1C in 74% of patients in this study deteriorated compared to 26% whose diabetes control improved. COVID-19 pandemic has helped healthcare professional to be more flexible and innovative in managing patients with diabetes and other chronic conditions (Monaghesh,E, Hajizadeh, A 2020).