Abstract
Introduction: The impact of the COVID-19 pandemic state and county orders for home isolation and social distancing on glycemic control in diabetics is yet to be understood. We aimed to evaluate the impact of California’s 2019 shelter-in-place (SiP) order (mandated from March to June 2020) on glycemic control, blood pressure, and body mass index in the Kaiser Permanente Northern California (KPNC) diabetic population. Methods: This is a retrospective cohort study of Kaiser Permanente Northern California members, age ≥ 18 years old with a diagnosis of type 1 or type 2 diabetes prior to 2019. We evaluated the change in glycated hemoglobin (HbA1c), body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), use of oral hypoglycemic agent (OHA), and use of insulin for diabetics, stratified by pre-SiP HbA1c level (<7, 7-8, 8-9, 9-10, and >10%) prior to and following the SiP order. Results: A total of 168,621 diabetics were included. Prior to the SiP, the mean HbA1c was 7.45 (1.48)%, with a mean BMI of 31.81 (7.29), SBP 133.04 (13.84), DBP 70.79 (9.97), 72.06% OHA users and 28.64% insulin users. Following SiP, the mean HbA1c was 7.49 (1.57)%, BMI 31.51 (7.39), SBP 134.12 (15.68) and DBP 71.30 (10.52), and 72.41% OHA users and 29.25% insulin users. A marginal decrease in BMI, was seen across all groups. Increases in HbA1c, SBP, DBP were highest in the HbA1c<7% and 7-8% groups (p<0.0001, Table 1). Conclusions: Marginal increases in HbA1c, SBP and DBP were seen in this diabetic cohort following the California 2020 SiP order. Increased use of OHA and insulin were seen following SiP, with insulin initiation in the highest HbA1c groups. The study helps to identify diabetics in our Northern California cohort that require more intensive management in the post-pandemic era. Further studies will help characterize long-term impacts on risk factors and incident cardiovascular disease.
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