key: cord-0808047-bgnoavtt authors: Sharma, Anu; Greene, Dina N.; Chambliss, Allison B.; Farnsworth, Christopher W.; French, Deborah; Herman, Daniel S.; Kavsak, Peter A.; Merrill, Anna E.; Margaret Lo, Sheng-Ying; Lyon, Martha E.; Winston-McPherson, Gabrielle; Pearson, Lauren N.; SoRelle, Jeffrey A.; Waring, Avantika C.; Schmidt, Robert L. title: The Effect of the Covid-19 Shutdown on Glycemic Testing and Control date: 2021-04-28 journal: Clin Chim Acta DOI: 10.1016/j.cca.2021.04.018 sha: 5f8132de31348617b0bbfb363cd10fefbd373ae9 doc_id: 808047 cord_uid: bgnoavtt Background The coronavirus disease 2019 (COVID-19) pandemic caused a halt to in-person ambulatory care. We evaluated how the reduction in access to care affected HbA1c testing and patient HbA1c levels. Methods HbA1c data from 11 institutions were extracted to compare testing volume and the percentage of abnormal results between a pre-pandemic period (January-June 2019, period 1) and a portion of the COVID-19 pandemic period (Jan-June 2020, period 2). HbA1c results greater than 6.4% were categorized as abnormal. Results HbA1C testing volumes decreased in March, April and May by 23, 61 and 40% relative to the corresponding months in 2019. The percentage of abnormal results increased in April, May and June (25, 23, 9%). On average, we found that the frequency of abnormal results increased by 0.31% for every 1% decrease in testing volume (p < 0.0005). Conclusion HbA1c testing volume for outpatients decreased by up to 70% during the early months of the pandemic. The decrease in testing was associated with an increase in abnormal HbA1c results. The year 2020 brought with it the coronavirus disease 2019 pandemic 63 that resulted in a global shutdown [1] . In March 2020, after the World Health 64 Organization (WHO) declared the pandemic, many outpatient clinics were closed to in-65 person visits in an attempt to slow the spread of disease. This resulted in many 66 institutions scrambling to get telehealth platforms in place to provide continuity of care to 67 their patients with chronic diseases. In Northern America (U.S. and Canada), diabetes 68 mellitus is amongst the most prevalent chronic diseases [2, 3] . Primary care teams 69 screen and make the initial diagnosis of diabetes mellitus. Standard of care for people 70 with diabetes mellitus includes follow up visits every 3-6 months depending on the 71 patient's medication regimen and the previous glycemic control [4] . In both scenarios, 72 measurement of HbA1c typically occurs at the time of these in person visits and is 73 essential for monitoring glycemic control. 74 With the shift to telehealth, many diabetes centers had to adjust their chronic care 75 flow. In Padua, Italy, there was a 47.7% decrease in outpatient diabetes visits during 76 shutdown [5] . With this reduction, they saw that older patients with more comorbidities 77 were less likely to be seen. Worryingly, the use of medications to reduce complications 78 from diabetes mellitus was decreased. HbA1c data from 11 institutions was extracted to compare testing volume and the 82 percentage of abnormal results between a pre-pandemic period (January-June 2019, HbA1c results. HbA1c results greater than 6.4% were categorized as abnormal. Point-of-care results and laboratory-based results were aggregated. 88 We determined the impact of the pandemic by comparing the testing volumes 89 and the percentage of abnormal results for each month in period 1 and period 2. We and 40% relative to the corresponding months in 2019 but increased by 2% in June. There was little change in the frequency of abnormal results over the first three months 132 of 2020 ( = 2, -1 and -4%); however, the frequency of abnormal tests increased by 133 about 19% in April and May, and returned to baseline in June ( = 2%). The volume of HbA1c testing for inpatients increased by about 7% in January results ranged from a decrease of 2% to an increase of 5%. The volume of HbA1c testing for outpatients increased by 14 and 23% in January We tested for a relationship between the percent change in testing volume ( ) 144 and the percent change in abnormal HbA1c results (ΔA) among outpatients Ten of 11 145 locations showed a negative relationship between testing volume and abnormal HbA1c 146 result frequency (Fig. 3) States and Canada. In addition, the relationship between the testing volume and the 228 frequency of abnormal results was consistent in 91% of centers (10/11). The data reflect 229 sampling from people who accessed care and are therefore at risk to selection and/or 230 convenience bias. The parameters measured were volume of HbA1c testing and 231 therefore further conclusions beyond those mentioned are unable to be drawn. Underlying characteristics of the individuals who were tested and why they did get 233 tested are unknown. In particular, we were unable to distinguish between tests 234 performed for screening, diagnosis and monitoring. The COVID-19 pandemic brought with it a major disruption to outpatient care. This highlighted a significant deficit in glycemic monitoring by traditional measures 237 (HbA1c). It also brought to light the benefits of telehealth. COVID-19: The first documented coronavirus pandemic in history Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US Impact of the 2020 COVID-19 Pandemic on 273 Ambulatory Hepatitis C Testing COVID-19 Pandemic Significantly Decreases Acute Surgical Complaints Decrease in acute coronary syndrome presentations during the COVID-19 pandemic in upstate 278 New York Management of hip 280 fractures during the COVID-19 pandemic at a high-volume hip fracture unit in the United Kingdom Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New 284 York City area Telemedicine: A Guide to Assessing Telecommunications in Health Care Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 289 randomized controlled trials Writing original draft Chambliss: Investigation, Review and Editing Farnsworth: Investigation, Review and Editing; Deborah French: Investigation, Review 339 and Editing Kavsak: Investigation, Review 340 and Editing 341 Methodology, Investigation SoRelle: Investigation, Review and Editing Waring: Writing -First Draft, Investigation, Review and Editing Formal Analysis, Writing original draft, Review and Editing