Impact of COVID-19 pandemic on HbA(1c) management and results in pediatric and adult outpatients with diabetes

OBJECTIVES: Diabetes mellitus intensify the risks and complications related to COVID-19 infection. A major effect of the pandemic has been a drastic reduction of in-person visits. The aim of this study was to evaluate the impact of the COVID-19 pandemic on HbA(1c) management and results among pediatric and adult outpatients with diabetes, considering the laboratory and point-of-care testing (POCT) HbA(1c) measurements. METHODS: Observational retrospective study including patients from pediatric and adult diabetes units was conducted. HbA(1c) results obtained in the laboratory and POCT over 3 years (2019–2021) were collected from the laboratory information system. RESULTS: After the lockdown, the number of HbA(1c) plummeted. Children returned soon to routine clinical practice. The number of HbA(1c) increased gradually in adults, especially in POCT. Globally, HbA(1c) results were lower in children compared with adults (p<0.001). HbA(1c) values in children (p<0.001) and adults (p=0.002) decreased between pre-pandemic and post-pandemic periods, though lower than the HbA(1c) reference change value. The percentage of HbA(1c) results above 8% remained stable during the study period. CONCLUSIONS: Continuous glucose monitoring and a telemedicine have been crucial, even allowing for improvements in HbA(1c) results. During the lockdown, patients with better metabolic control were managed in the laboratory whereas patients with poorer control or a severe clinical situation were attended in diabetes units by POCT. Adults returned to pre-pandemic management slowly because they were more susceptible to morbidity and mortality due to COVID-19. Coordination among all health professionals has been essential to offering the best management, especially in difficult scenarios such as the COVID-19 pandemic.