https://orcid.org/0000-0003-3560-8860
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Abstract
Purpose
We aimed to examine the effect of the COVID-19 pandemic and lockdown on monitoring and treatment balance of Finnish coronary heart disease (CHD) and type 2 diabetes (T2D) patients.
Patients and Methods
We used data from the electronic health records on 1604 CHD and 10,136 T2D patients aged 18‒85 years in Eastern Finland. Measurement and levels of low-density lipoprotein cholesterol (LDL) of CHD patients and glycated haemoglobin (HbA1c) of T2D patients were assessed monthly during January 2019–June 2021. Interrupted time-series analysis design was utilized to examine the effect of the lockdown on proportion of patients monitored and treatment balance.
Results
Reductions in frequencies of LDL testing of CHD and HbA1c testing of T2D patients were observed during the national lockdown. Downward trend in average LDL was observed from January 2019 until June 2021. Average HbA1c values increased from January 2019 to March 2020 with an additional increase by 2.04 mmol/mol (0.80 to 3.29) in April 2020. However, there was a downward trend in monthly average HbA1c during the lockdown until June 2021 with an additional change in level by 0.61 mmol/mol (95% CI 0.06 to 1.16) in July 2020.
Conclusion
The lockdown decreased the frequency of monitoring among both CHD and T2D patients. Meanwhile, monthly average LDL had a steadily improving pattern in CHD patients during the follow-up while temporary worsening in HbA1c in patients with T2D was observed at the time of the lockdown. The lockdown may have introduced selection in patients who had their treatment outcomes monitored. Better self-management of risk factors among patients is also possible.
Abbreviations
CHD, coronary heart disease; EHR, electronic health register; HbA1c, hemoglobin A1c; IFCC, International Federation of Clinical Chemistry; ITS, interrupted time-series; LD, lockdown; LDL, low-density lipoprotein cholesterol; T2D, type 2 diabetes; TB, treatment balance; TINIA, turbidimetric inhibition immunoassay method.
Data Sharing Statement
Access to data is regulated by the European Union and Finnish laws and therefore, sharing of sensitive data is not possible and data are not publicly available. An anonymized version of the data is available for researchers who meet the criteria as required by the European Union and Finnish laws for access to confidential data with a data permit of an appropriate authority. Contact information: [email protected] for data requests from the Siun sote – Joint municipal authority for North Karelia social and health services.
Ethics Approval and Informed Consent
Use of the data was approved by the Ethics Committee of the Northern Savonia Hospital District (diary number 81/2012). The study protocol was also approved by the register administrator, the Siun sote. Only register-based data were utilized and thus, consent from the patients was not needed.
Consent for Publication
All authors confirm that the details of any images, etc. can be published, and that the persons providing consent have been shown the article contents to be published.
Disclosure
JM is a founding partner of ESiOR Oy and a board member of Siltana Oy. These companies were not involved in carrying out this research. PL, M-LL, TR, LI, and TL declare no conflicts of interest.