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. 2025 Jun:224:112195.
doi: 10.1016/j.diabres.2025.112195. Epub 2025 Apr 21.

Changes in diabetes screening and exercise during the COVID-19 pandemic in adults with prediabetes

Luis A Rodriguez  1 , Maher Yassin  2 , O Kenrik Duru  3 , Romain S Neugebauer  4 , Susan D Brown  5 , Yelba Castellon-Lopez  6 , Tainayah W Thomas  7 , Julie A Schmittdiel  4
Affiliations

Changes in diabetes screening and exercise during the COVID-19 pandemic in adults with prediabetes

Luis A Rodriguez et al. Diabetes Res Clin Pract. 2025 Jun.

Abstract

Aims: To evaluate changes in type 2 diabetes mellitus (T2DM) screening and exercise during the COVID-19 shelter-in-place, and whether Medicaid patients and racial/ethnic minoritized groups were disproportionally affected.

Methods: Retrospective cohort study of 578,585 adults with prediabetes aged ≥ 18-89 years with BMI ≥ 25 (≥23 if Asian) at Kaiser Permanente Northern California from January 2019 to December 2021. We used separate interrupted time-series analyses of aggregated weekly T2DM screening rates, or mean exercise minutes, to evaluate any decrease associated with the shelter-in-place (March 19, 2020, to June 1, 2020). Analyses were performed in 2023-2024.

Results: Before Covid, 121/10,000 patients/week were screened for T2DM, and patients exercised 107 min/week. Initially, screening dropped to near zero (by ∼ 96 %) followed by a slow increase of 7.4 (95 % CI: 2.4-12.4, p-value 0.004)/10,000 patients/week during the shelter-in-place. Similarly, exercise decreased initially by 37 (29-45, p-value < 0.001) minutes/week, followed by a slow increase of 3.5 (1.7-5.4, p-value < 0.001) minutes/week during the shelter-in-place. These patterns were similar across racial/ethnic groups; however, Medicaid patients took 1.5 years to resume baseline exercise levels.

Conclusions: The shelter-in-place was associated with an abrupt decrease in T2DM screening and exercise among adults with prediabetes. Future mandates should support high-risk populations, especially Medicaid, to maintain T2DM screening and exercise to prevent T2DM progression.

Keywords: COVID-19 pandemic; Exercise; Medicaid; Race and ethnicity disparities; Shelter-in-place mandate; Type 2 diabetes mellitus screening.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Trend in Weekly Type 2 Diabetes Screening Rates in Adults with Prediabetes at Kaiser Permanente Northern California Before, During, and After the COVID-19 Shelter-In-Place Mandate.
Fig. 2.
Fig. 2.
Trend in Weekly Mean Exercise Minutes in Adults with Prediabetes at Kaiser Permanente Northern California Before, During, and After the COVID-19 Shelter-In-Place Mandate.
See this image and copyright information in PMC

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