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

OBJECTIVE. To 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. METHODS. We 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. RESULTS. In 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%)). CONCLUSIONS. Over 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.