Impact of the COVID-19 Pandemic on Diabetes Mellitus Care in Portugal

OBJECTIVES: The COVID-19 pandemic was declared by the World Health Organization on 11 March 2020.¹ Worldwide, healthcare utilization decreased by about a third between the pre-pandemic and pandemic periods.² This study aims to evaluate the impact of the COVID-19 pandemic on the healthcare provided to patients with diabetes in Portugal, and its consequences on morbidity and mortality.

METHODS: The pre-pandemic and pandemic periods were compared using publicly available data on performance and health outcomes indicators of the Portuguese National Health Service (NHS)³, namely the number of registered users with diabetes mellitus (DM) and ≥1 glycated haemoglobin A1c (HbA1c) measurement over 6 months, and the proportion of diabetics with HbA1c ≤8%. Pre-pandemic data were modelled to project hypothetical scenarios without a pandemic using an exponential smoothing algorithm, and then compared with data collected during the pandemic. A cohort model was developed to estimate the number of all-cause deaths and years of life lost (YLL) due to the reduction in HbA1c testing and in HbA1c records ≤8% during the COVID-19 pandemic's first two years. MS Excel® was used for statistical analyses.

RESULTS: There was a 14.9% relative reduction in the number of DM patients with a HbA1c measurement, and a 16.1% relative reduction in the proportion of patients with DM with controlled disease (HbA1c ≤8%) during the first two years of the pandemic. The model projections are 379 additional deaths in the Portuguese diabetic population and 4,813 YLL due to the increased proportion of DM patients with uncontrolled disease.

CONCLUSIONS: The disruption in healthcare provision by the Portuguese NHS during the pandemic increased DM morbidity, with a higher proportion of uncontrolled patients, thus contributing to increase mortality. The pandemic's impact on other routine diabetes care processes should be assessed, along with the long-term implications of impaired care.