Impact of the COVID-19 Pandemic in the Netherlands on Primary Healthcare Use and Clinical Outcomes in People with Type 2 Diabetes
van den Berg J1, Blom MT2, Swart-Polinder KMA3, Overbeek J3, Remmelzwaal S2, Elders PJM2, Herings RMC3
1PHARMO Institute for Drug Outcomes Research, Utrecht, UT, Netherlands, 2Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands, 3PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
OBJECTIVES: The COVID-19 pandemic has disrupted healthcare systems globally, resulting in the postponement or cancellation of critical appointments and procedures, including chronic care for type 2 diabetes (T2D) patients in the Netherlands. During the first wave of the pandemic, general practitioners (GPs) supposedly saw fewer T2D patients. This study aimed to determine the pandemic's effect on healthcare utilization and clinical outcomes among T2D patients.
METHODS: The study analyzed data from the DIAbetes MANagement and Treatment (DIAMANT) cohort, which comprises electronic medical records of Dutch GPs. Descriptive analyses, negative binomial models and GEE models were used to evaluate patient characteristics and clinical measurements, including HbA1c, BMI, LDL, eGFR, and blood pressure, in 2019 and 2020. The study compared values of clinical measurements and GP visits in both years.
RESULTS: The cohort included 191,267 T2D patients (47% women, mean age 69 (± 13) years) on March 1, 2019. Results indicated a reduction in clinical measurements in 2020, specifically for blood pressure (-31%), BMI (-28%), HbA1c (-17%), LDL (-9%), and eGFR (-8%). While the number of GP office visits (+7%) and phone calls (+29%) increased, home visits decreased (-7%). On population level, there was a significant 1.6 mmol/mol increase in HbA1c levels in 2020 compared to 2019. Observed changes in BMI, LDL, and blood pressure were statistically significant but small. Changes were greater in low-risk populations.
CONCLUSIONS: During the first year of the pandemic in the Netherlands, changes in primary healthcare use were observed among T2D patients, with an increase in GP office visits and phone calls and a decrease in clinical measurements and home visits. Moreover, there was an increase in HbA1c levels in 2020. Future research is needed to determine the pandemic's potential impact on patients with less healthcare utilization in 2020 and whether the increase in HbA1c levels is associated with long-term T2D complications.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Clinical Outcomes Assessment
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas