Longitudinal impact of COVID-19 pandemic on the utilization of hemoglobin A1c testing in outpatients
Li Zha1, Sara MacLeod2, Tanzy Love3
1Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States; Present Address: Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, United States.
Insights
The COVID-19 pandemic saw a small decrease in hemoglobin A1c (HbA1c) testing frequency, but disparities did not worsen. Testing remained within recommended guidelines for diabetes management.
Area of Science:
- Health Services Research
- Clinical Chemistry
- Epidemiology
Background:
- Concerns about healthcare access disparities during the COVID-19 pandemic.
- Limited data on the pandemic's impact on diabetic laboratory testing across demographic groups.
Purpose of the Study:
- To assess the pandemic's effect on hemoglobin A1c (HbA1c) testing frequency.
- To investigate potential widening of disparities in HbA1c testing rates.
Main Methods:
- Retrospective analysis of outpatient HbA1c testing data from March 2019 to March 2021.
- Utilized multivariate Poisson regression to evaluate pandemic's impact on HbA1c utilization.
Main Results:
- Analyzed over 190,000 HbA1c results from a predominantly white and older patient population.
- Observed a small, significant decrease in average HbA1c tests per patient during the pandemic.
- Testing frequency remained within American Diabetes Association guidelines for most patients.
Conclusions:
- Reassuringly, no worsening of disparities in HbA1c testing rates was observed during the pandemic.
- Healthcare disruptions did not appear to exacerbate existing inequities in diabetic testing access.
Background:
During the COVID-19 pandemic, concerns arose about disparate access to health care and laboratory testing. There is limited information about the pandemic's impact on the frequency of diabetic laboratory testing across demographic subgroups (e.g., sex, age over 65 y, and race).
Methods:
This retrospective study examined outpatient hemoglobin A1c (HbA1c) testing in a large academic medical center in Upstate New York between March 2019 and March 2021. Multivariate Poisson regression models were used to evaluate the pandemic's effects on HbA1c utilization.
Results:
Over 190,000 HbA1c results from predominately white (76.1 %) and older (mean age, 60.6 y) outpatients were analyzed. Compared to pre-pandemic time period, the average number of HbA1c tests per patient during COVID time period experienced a small, though significant, drop (1.3 to 1.2; p < 0.001) on aggregate and in outpatients, males, females, and seniors. The modest reduction was not significant by race except for the white seniors (p < 0.001). However, the testing frequency remained within recommendations from the American Diabetes Association for monitoring prediabetic patients and patients with stable glycemic control.
Conclusion:
Given the propensity for healthcare disruptions to widen disparities, it is reassuring that we did not observe a worsening of disparities in rates of HbA1c testing during the COVID-19 pandemic.
Related Concept Videos
01:19Overview of Carbohydrate Metabolism
Glucose transport into cells is facilitated by a family of transport proteins called GLUT (Glucose Transporters). GLUT4 is the primary glucose transporter for insulin-stimulated glucose...
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:22Diabetes Mellitus: Type 2 and Gestational