This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.
COVID-19 and pandemic response measures implemented to limit its spread have resulted in various indirect health impacts due to the disruption of many preventative, diagnostic, and management services. The extent of their impacts on the diabetes care cascade are not known. South Asians, representing 25 percent of the visible minorities have highest burden of Type 2 diabetes. Higher incidence of COVID-19 was reported in neighborhood areas with higher density of South Asian population in British Columbia (BC) and Ontario. However, it is not known if diabetes care cascade among South Asians was impacted more than other population groups.
We aim to assess: a) The impact of COVID-19 pandemic on the diabetes care cascade, b) Differential impact in South Asians vs other population groups; c) Patient/provider perceptions of disruption of services.
We will use BC COVID-19 Cohort which integrates daily COVID-19 lab tests, case follow-up data, COVID-19 immunizations, hospital and ICU admissions, with demographic, healthcare utilization datasets (medical visits, hospital admissions, emergency room visits, dispensed prescription drugs) Chronic Disease Registry and socioeconomic data and data from BC SPEAK Survey. We will construct care cascade in pre-pandemic years and pandemic/post pandemic years and apply a combination of epidemiological and statistical techniques to investigate the stated aims. We will gather qualitative data based on interviews with diabetes patients and care providers to provide context and inform interventions to prevent further disruptions and optimize care.
This project will characterize the extent of disruption in services across diabetes care cascade and will identify characteristics of population most affected. We will provide evidence on disparities experienced by South Asians and identify strategies to mitigate the impacts of the COVID-19 pandemic or future similar health emergencies for individuals with diabetes.
Source: CIHR Funding Decisions Database
End of Award Update – December 2024
Results
We used population-based linked administrative data to investigate the impact of the COVID-19 pandemic and related control measures on screening and diagnoses of type 2 diabetes. Our analysis shows a significant overall decline in diabetes screening and diagnoses following the declaration of a public health emergency in BC and initial implementation of pandemic measures. However, there was evidence of a slight but insignificant increase in screening and a significant 31.6% increase in diabetes diagnoses in the third post-pandemic policy phase (Jan 2022- Dec 2022). Stratification by sex and age shows the upward trend in diabetes diagnoses is essentially being driven by females and relatively younger age groups.
Impact
This study has shown the profound indirect impact of the COVID-19 pandemic and its related measures on chronic disease management and the scale of disruptions to the timely screening and diagnosis of type 2 diabetes. While screening for type 2 diabetes still does not appear to have recovered fully to the pre-pandemic levels, we observed an increase in the diagnoses of diabetes in post-pandemic period compared to the expected. Increased trends in diagnoses are being driven almost exclusively by relatively younger females. Additionally, diabetes diagnoses at younger age means a higher risk of developing micro and macrovascular complications of diabetes much earlier and with more severe complications, leading to increased morbidity and mortality.
Potential Influence
Our research findings have important implications and require a reprioritization of clinical guidelines and public health policies and targeted interventions for increased screening for timely diagnosis of diabetes. This work underscores the need for critical future research to understand underlying causes (other than a backlog) that may be driving this epidemic of diabetes – specifically among females. Additionally, future research is needed to understand how ethnicity and social deprivation might explain these differences so that targeted strategies and interventions can be developed to tackle these crises in the most vulnerable and high-risk population subgroups.
Next Steps
This work has been shared with and presented in international conferences. Additionally, this work has sparked interest within many groups and stakeholders in BC and opened opportunities for future collaboration.