Testing Times - the Impact of the Pandemic on Hba1c Monitoring and Targets

ABSTRACT

Aims NICE guidance suggests that children with diabetes have HbA1c measurements taken 4 times a year.1 However, a change to practice brought in by restrictions during the COVID 19 pandemic meant clinics were by telephone rather than face to face (F2F). We sought to evaluate what affect this change had on the regularity of HbA1c monitoring and of HbA1c targets in our hospital population. Methods HbA1c levels for all patients with diabetes seen at Musgrove Park Hospital, Taunton, were reviewed over 2 time periods. Pre covid, March 2019-March 2020 when F2F clinics were held and during covid, March 2020-March 2021. Telephone clinics were used between March-October 2020, with F2F resuming after this date. Patients were excluded if they had been diagnosed since March 2020 or had transferred to our hospital. Results 78 patients pre covid and 83 patients during covid were included in analysis. Duration between HbA1c blood tests pre covid showed a mean of 3.1 months with a range of 1-7months. During covid the mean duration between tests was 10.9 months with a range of 7-18 months. See figure 1 Change in HbA1c in each patient was measured from baseline. Baseline was considered to be the first measurement from March 2019 in the 'pre covid group' and the last pre covid measurement in the 'during covid group'. The majority of patients (78%) in the year pre covid and 65% during covid stayed within -10 and +10 mmol/ml of their baseline. However, during covid there were more large increases in HbA1c. This demonstrated in figure 2. A comparison was also made with the national targets for HbA1c. The most striking difference is the number of patients with HbA1c >80mmol/ml. Increasing from 9 pre covid (11.5%) to 28 during covid (34%). There were also fewer patients reaching the target of <48mmol/ml halving from 14 to 7 (18% to 8%).Conclusion As suspected, the interval between HbA1c measurements increased during the covid pandemic whilst telephone consultations were used and the target of 4 times per year was not reached. Patients were sent kits to test HbA1c at home but these were used rarely. The results also show that during this period of covid restrictions and telephone clinics, there is a wider spread of HbA1c measurements. There were a small number of patients who saw a rapid and large rise in HbA1c measurements. In particular and most concerning is an increase in the number of patients with HbA1c >80mmol/ml (11.5% of patients pre covid to 34% after covid). We can only speculate as to what may have caused this. Perhaps the lack of direct contact with the clinical team, a change in activity levels and diet during the lockdown restrictions, or the psychological impact of the lockdown restrictions.