The Impact of Covid-19 on Diabetes Care in Muscat Governorate: A Retrospective Cohort Study in Primary Care

Abstract

Background: COVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients' and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients' glycemic outcome in Oman.

Aim and objectives: To explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients' glycemic outcome.

Methods: Before and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients' glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients' HbA1c and mode of consultation was measured using multivariable regression analysis.

Results: A total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), P = .002. With multivariable linear regression, the mean difference in HbA1c was -0.3 (-2.3 to 1.5), P = .734 for telephone consultation alone, -0.5 (-2.4 to 1.4), P = .613 for face-to-face alone, and -0.5 (-2.4 to 1.3), P = .636 for combined consultations, compared to those who did not receive any formal consultation.

Conclusion: Despite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.

Keywords: COVID-19; Oman; diabetes; primary care.

Figure 1.

Flow of participants through study period before and after COVID-19 pandemic announcement, between 2019 and 2020. ^aBefore pandemic announcement in the year 2019. ^bAfter pandemic announcement in the year 2020. DM, diabetes mellitus; HbA1c, glycated hemoglobin. ^cPatients with loss of follow up are those who did not attend their scheduled appointment either by face-to face, neither by telephone. The reason for this is assumed to be due to fear from acquiring coronavirus infection as many of these patients were seen in clinic later on after the study period.