Title: Understanding Type II Diabetes Insulin Management During The COVID-19 Pandemic: Findings from a Hospital and a Clinic

Purpose: COVID-19 disrupted the care of people with diabetes. It is not clear how the disrupted care impacted medication safety and diabetic control outcomes. During the pandemic, questions emerged regarding whether patients experienced changes in care that led to higher glucose levels, inappropriate medication changes and poorer health outcomes. The role of strategies to control glucose, such as the use of antidiabetic drugs has been established. We examined safety issues related to the association between insulin use and diabetic control among diabetic patients during COVID-19. Results: After examining 42 patient cases, it is noted that most (55%) patients had controlled A1C (pre-Covid vs Covid-era). (55%) of patients whose A1C was < 8% (pre-Covid vs Covid era) were prescribed insulin compared to (45%) of patients who had an A1C >8% (pre-Covid vs Covid era). The cease in insulin prescribing (pre-Covid vs Covid era) increased the A1C levels for uncontrollable patients. Conclusion: During the COVID pandemic, gaps in insulin prescriptions were associated with occurrences of diabetic control status changing to uncontrolled status, indicating patient safety issues. Monitoring insulin prescribing among diabetic patients during the pandemic may identify care gaps and help to improve patient care outcomes.