Abstract
Introduction: Avoidance of health services, including ED, is problematic. Evidence has demonstrated that such missed attendances are associated with worse health, faster declines in functioning, and higher rates of mortality long-term.
People with diabetes represent a large fraction of Emergency Department (ED) and General Practice (GP) attendances. At the onset of the COVID-19 pandemic in March 2020, there was a reduction in the number of people with diabetes attending ED and GP. This may be explained by people with diabetes avoiding care due to a perceived or real risk of COVID-19 cases in the community.
Methods: A retrospective cohort study examining trends in diabetes attendance rates and the reasons behind these changes, using a time-series database of 160,000 HbA1c tests done at Blacktown and Mt Druitt hospitals was undertaken, as well as a review of over 1.8 million (GP) records. Rates of diabetes in ED were analysed over time. Stata 15.1 was used to run a series of time-varying regressions as well as an interrupted time series analysis looking at outbreaks of COVID-19 in NSW.
Results: The average rate of diabetes in ED fell from 17.8% pre-pandemic to 15% after January 2020 (p<0.001). This rate has fluctuated over time as the pandemic waxed and waned, with fewer people attending both during periods of lockdown and when there was a suspected outbreak in the community. There is also a significant interaction with age, with the proportion, but not the absolute number, of young people increasing substantially since the pandemic began. This was offset by an increase in telehealth, particularly in GPs, which may have to some extent replaced the care provided in ED.
Discussion: During the COVID-19 pandemic, the cohort of people with diabetes attending ED shifted to a younger group, more often born in Australia. Moreover, the proportion of people with well-controlled and undiagnosed diabetes has continued to fall over the last 2 years. This is associated with a lower usage of diabetes services by these patient groups as well, displaying a worrying trend for people with diabetes to avoid care and indicating an urgent need to engage with these individuals through non-traditional means. However, this may have been offset with primary care services, as well as new virtual care services provided by the hospital in this period.