Indirect effects of the COVID-19 pandemic on people with type 2 diabetes: time to urgently move into a recovery phase

In this issue of BMJ Quality and Safety, Carr and colleagues provide important data on the scale of interruptions in the routine management of patients with T2D in UK primary care before and after the first peak of the COVID-19 pandemic.9 This large cohort study of 161 181 patients with T2D assessed temporal changes in the rates of diabetes health checks (or ‘care processes’) recommended by the English National Institute for Health and Care Excellence (NICE), and the prescribing of medications to people with T2D. England’s first national COVID-19 lockdown was in place between late March and May 2020. The authors assessed six selected care processes during three time periods: April 2020 (first full month of national lockdown), May–December 2020 (recovery period) and March–December 2020 periods (lockdown and recovery periods combined), and compared the observed rates during these periods and the expected rates based on 10-year pre-pandemic trends

Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes

OBJECTIVE: The associated risk of vascular disease following diagnosis of type 2 diabetes in people previously identified as having pre-diabetes in real-world settings is unknown. We examined the presence of microvascular and macrovascular disease in individuals with newly diagnosed type 2 diabetes by glycemic status within 3 years before diagnosis. RESEARCH DESIGN AND METHODS: We identified 159 736 individuals with newly diagnosed type 2 diabetes from the UK Clinical Practice Research Datalink database in England between 2004 and 2017. We used logistic regression models to compare presence of microvascular (retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular and peripheral arterial disease) disease at the time of type 2 diabetes diagnosis by prior glycemic status. RESULTS: Half of the study population (49.9%) had at least one vascular disease, over one-third (37.4%) had microvascular disease, and almost a quarter (23.5%) had a diagnosed macrovascular disease at the time of type 2 diabetes diagnosis.Compared with individuals with glycemic values within the normal range, those detected with pre-diabetes before the diagnosis had 76% and 14% increased odds of retinopathy and nephropathy (retinopathy: adjusted OR (AOR) 1.76, 95% CI 1.69 to 1.85; nephropathy: AOR 1.14, 95% CI 1.10 to 1.19), and 7% higher odds of the diagnosis of acute coronary syndrome (OR 1.07, 95% CI 1.03 to 1.12) in fully adjusted models at time of diabetes diagnosis. CONCLUSIONS: Microvascular and macrovascular diseases are detected in 37%-24% of people with newly diagnosed type 2 diabetes. Pre-diabetes before diagnosis of type 2 diabetes is associated with increased odds of microvascular disease and acute coronary syndrome. Detection of pre-diabetes might represent an opportunity for reducing the burden of microvascular and macrovascular disease through heightened attention to screening for vascular complications