Impact of COVID-19 restrictions on diabetes mellitus management in Qatari primary care settings
Authors: Nuaimi Ahmed Sameer Al , Alam Muhammad Tanveer , Hassan Mariam , Syed Mohamed Ahmed 
Published: January 2024

Abstract
Introduction
In 2019, Coronavirus Diseases 2019 (COVID-19) emerged as a pandemic making diabetic patients among the most vulnerable to this virus. Previous studies showed contradicting evidence for the impact of “lockdown” on the management of diabetic patients. New models of service delivery were introduced in Primary Health Care Corporation (PHCC) (Qatar’s largest primary care provider) to ameliorate the risk of infection to both patients and health care workers including converting face to face chronic disease appointments (NCD, antenatal, and preventive visits) to telephone and video consultations. This study aimed to compare access and outcomes of PHCC registered diabetics pre-COVID and during the COVID-19 lockdown period.

Methods
The study was conducted as a 3 year historic cohort using PHCC’s electronic health record system. Individuals with an established diagnosis of diabetes mellitus (DM) before January 2019 and having at least one clinical encounter per year in a PHCC health center during the study period starting Jan 2019 to Dec 2021 were recruited. Pre-COVID-19 period was defined as the interval between January 2019 and February 2020, while the COVID-19 lockdown period was defined as the interval between February 2020 to December 2021. The study used a paired observation approach on selected process indicators on delivery of health services in line with PHCC’s diabetes management guidelines (at least two HbA1C tests done per year and at least one each of the following per year—low-density lipids (LDL) test, ophthalmology screening, podiatry assessment, health education and dietetics clinic consultations) and outcome indicators (blood pressure readings and the results of two laboratory tests: blood HbA1c and serum LDL level).

Results
COVID-19 was associated with an overall mean reduction of 0.9 per year of consultations. Similarly, the delivery of annual assessments as per guidelines were also impacted. Of these, the probability of achieving the designed target for two HbA1C tests per year was reduced by almost a half (paired OR=0.47) during COVID-19 compared to pre- COVID-19 period. Conversely, a significant increase in the probability of having at least one each of LDL test, ophthalmology screening and dietetics consultation was observed (paired OR=1.84, 1.62 and 1.94 respectively) during COVID-19. The probability of having inadequate glycemic control (HbA1C > =7%) was significantly increased by 32% during COVID-19 period. Likewise, the probability of experiencing inadequately controlled blood pressure was significantly increased by 47% during the pandemic. Conversely, the probability of having Inadequately controlled blood lipids (LDL 2.6 mmol/L+) was significantly reduced by 9%.

Conclusions
The impact of the COVID-19 pandemic on the primary health care services in Qatar has highlighted PHCC’s resilience by the introduction of virtual consultations during COVID-19 restrictions. Only one process indicator was significantly impacted during COVID-19 restrictions, namely having at least two HbA1C tests per individual with diabetes per year. However, the control of the disease according to HbA1c and blood pressure measurements showed a noticeable deterioration during COVID-19.