Trend and quality of care for diabetic patients in diabetes outpatient clinics before and during the COVID-19 pandemic

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BACKGROUND: The COVID-19 pandemic has intensified the burden of noncommunicable diseases, particularly diabetes mellitus. This study aims to examine the impact of the COVID-19 pandemic on the trend of diabetic care and its indices in Iran by comparing the periods before and during the pandemic. METHODS: In this trend analysis study, we used data from the National Program for Prevention and Control of Diabetes (NPPCD) database from March 2017 to June 2021 alongside national data on COVID-19 infection and mortality from February 2020 to June 2021. The t-test and general linear models were used to compare diabetes care indices before and during the COVID-19 pandemic and to analyze the weekly and monthly trends of visits in relation to COVID-19 infection and mortality, respectively. RESULTS: The results of this study revealed significant disruptions in outpatient diabetic care during the COVID-19 pandemic. The average weekly visits to diabetes outpatient clinics showed an inverse trend to COVID-19 infections and deaths. Comparing the pre-pandemic to the pandemic period, a notable shift observed in the gender distribution toward an increase in male patients (from 32.82% pre-pandemic to 35.94% during the pandemic, p-value, 0.018). Smoking prevalence rose significantly from 4.65% to 5.86% (p-value = 0.001). Hyperlipidemia decreased from 54.36% to 46.77% (p-value < 0.001), and metabolic syndrome prevalence declined from 63.2% to 61.98% (p-value < 0.001). Cardiovascular disease decreased from 21.04% to 18.63% (p-value = 0.013), while hypertension increased from 35.61% to 38.54% (p-value = 0.023). Regarding glucose-lowering therapies, the use of oral medications dropped significantly from 83.73% pre-pandemic to 78.94% during the pandemic (p-value < 0.001), while insulin use increased from 38.91% to 46.75% (p-value < 0.001). Analysis of laboratory findings showed a significant reduction in LDL > 100 mg/dl (36.69% to 33.03%, p-value = 0.006) and TG > 150 mg/dl (49.59% to 48.79%, p-value = 0.006). However, no significant differences were observed in HbA1c > 7% or diabetic complications (p-value > 0.05). CONCLUSION: The COVID-19 pandemic has profoundly impacted the care and management of diabetic patients in Iran, leading to contrasting trends in various diabetic care indices among diabetic patients who receive care in outpatient diabetes clinics. Notable improvements were observed in the prevalence of CVD, hyperlipidemia, and metabolic syndrome, while the prevalence of smoking and hypertension deteriorated. These findings underscore the need for adaptable healthcare strategies, especially for managing chronic conditions during health crises. Further studies are necessary to evaluate the long-term effects of the pandemic on diabetic care and patient outcomes.

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