Type II Diabetes Mellitus and COVID-19: A Case Series Exploring Insulin Management in Patients from Two Family Medicine Clinics

Purpose:

About 37 million Americans have diabetes and out of this population, over 90% of them have type 2 diabetes. An estimated $200 billion per year is spent on managing this disease.

There is limited data on factors that could explain whether diabetic patients experienced better HgbA1C control during the COVID-19 pandemic. The relationship between diabetes medications (DM) and diabetes outcomes during the COVID era is not well-characterized. In this case series, we aimed to evaluate type II diabetes outcomes pre-COVID-19 vs. COVID-19 era.

Methods:

This case series was conducted in two family medicine clinics that included patients with type II diabetes. The following data from all patients at least 18 years or older on 3/1/2019 were extracted: hemoglobin A1c, medication prescriptions (insulin use patterns, non-insulin prescription patterns oral diabetes medications), and number of prescriptions discontinued. We followed a guidance statement from the American College of Physicians in terms of how outpatient diabetes is managed and used A1c of less than 8% as the threshold to assess the clinical outcomes for this outpatient population. A1c values were compared between two cohorts, a pre-COVID-19 cohort (March 1, 2019-March 13, 2020) and a COVID-19 era cohort (March 14, 2020-March 31, 2021). An analysis was performed on all patients whose A1c control status was changed, defined as the last A1c in each of the two study periods changed either from > 8% to =< 8% (got better), or from =< 8% to > 8% (got worse). For each of the patients with A1c control status change, we identified patterns of diabetic medication prescriptions during the COVID-19 era: (1) insulin and other DM medications, (2) no insulin but other DM medication, or (3) insulin-only prescriptions.

Results:

Eighty-one patients fulfilled the study criteria. Fifty-three patients got better, and 28 patients got worse. Of the 52 cases, 28 got better due to insulin use. Eighteen of these patients discontinued their insulin at some point during the study period. Of the 28 patients that got worse. Out of the 26 cases, 10 of them got worse while on insulin. Nine out of 10 of these patients discontinued their insulin at some point during the study period. Only 1 patient was on their insulin medication throughout the entire study. Out of the 28 cases with some form of diabetes management therapy, 16 of them were on non-insulin medications. Thirteen out of 16 of these patients discontinued at least one of their medications at some point during the study period. 23 out of 26 patients discontinued at least one prescription.

Conclusion:

This case series demonstrates how two family medicine clinics treated diabetic patients during a pandemic. The majority were using insulin throughout COVID-19 era and did experience changes to their medication profile with other DM medications. A1c levels did change significantly from pre-COVID-19 to COVID-19 era, while prescriptions for diabetic treatment were reduced. This study identified the importance of keeping insulin and other DM medication prescriptions through a pandemic and how COVID-19 impacted Hemoglobin A1C and overall diabetes care.