TY - JOUR
T1 - What is the impact of structural changes in society on diabetes self-management and trajectories of HbA1c?
T2 - A cohort study before, during and after the COVID-19 pandemic in people with diabetes treated at outpatient clinics
AU - Rasmussen, Martin Gillies Banke
AU - Just-Østergaard, Emilie
AU - Stidsen, Jacob Volmer
AU - Willaing, Ingrid
AU - Pedersen, Grete Skøtt
N1 - Copyright: © 2025 Rasmussen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2025/8
Y1 - 2025/8
N2 - BACKGROUND: The impact of COVID-19-related changes in diabetes self-management and trajectories of HbA1c throughout COVID-19 is not fully understood. Here, we describe HbA1c trajectories, changes in diabetes self-management and their association before, during and after the COVID-19 pandemic (2019-2022).METHODS: During the spring of 2021, we invited 13,641 outpatients from diabetes clinics in the Region of Southern Denmark to complete a questionnaire regarding changes in diabetes self-management during COVID-19. We linked the questionnaire and registry HbA1c data from before, during and after the COVID-19 pandemic and conducted multivariable adjusted linear mixed-effect regression to assess the association between changes in diabetes self-management and HbA1c.RESULTS: 5,581 (40.9%) people responded to the questionnaire (median age: 65 years, males: 59.7%). HbA1c decreased in people with type 2-diabetes and was unchanged for people with type 1-diabetes (interaction: p < 0.001). The majority of people reported unchanged diet (65-71%) and usual medication taking (89-90%). No changes in physical activity were reported by 43%, while 42% reported decreased physical activity. HbA1c trajectories did not differ according to change in physical activity and change in diet intake, while taking medication more regularly was associated with a decrease in HbA1c, from approximately 65/66 mmol/mol (8.1/8.2%) to 60/61 mmol/mol (7.6/7.7%) in both diabetes types.CONCLUSIONS: During COVID-19, HbA1c trajectories differed between diabetes types. Most of the sample maintained usual diabetes self-management, although some decreased physical activity levels. Improved medication taking was associated with decreased HbA1c. This information is crucial for health professionals, in order to provide support aimed at reducing HbA1c.
AB - BACKGROUND: The impact of COVID-19-related changes in diabetes self-management and trajectories of HbA1c throughout COVID-19 is not fully understood. Here, we describe HbA1c trajectories, changes in diabetes self-management and their association before, during and after the COVID-19 pandemic (2019-2022).METHODS: During the spring of 2021, we invited 13,641 outpatients from diabetes clinics in the Region of Southern Denmark to complete a questionnaire regarding changes in diabetes self-management during COVID-19. We linked the questionnaire and registry HbA1c data from before, during and after the COVID-19 pandemic and conducted multivariable adjusted linear mixed-effect regression to assess the association between changes in diabetes self-management and HbA1c.RESULTS: 5,581 (40.9%) people responded to the questionnaire (median age: 65 years, males: 59.7%). HbA1c decreased in people with type 2-diabetes and was unchanged for people with type 1-diabetes (interaction: p < 0.001). The majority of people reported unchanged diet (65-71%) and usual medication taking (89-90%). No changes in physical activity were reported by 43%, while 42% reported decreased physical activity. HbA1c trajectories did not differ according to change in physical activity and change in diet intake, while taking medication more regularly was associated with a decrease in HbA1c, from approximately 65/66 mmol/mol (8.1/8.2%) to 60/61 mmol/mol (7.6/7.7%) in both diabetes types.CONCLUSIONS: During COVID-19, HbA1c trajectories differed between diabetes types. Most of the sample maintained usual diabetes self-management, although some decreased physical activity levels. Improved medication taking was associated with decreased HbA1c. This information is crucial for health professionals, in order to provide support aimed at reducing HbA1c.
KW - Humans
KW - COVID-19/epidemiology
KW - Male
KW - Glycated Hemoglobin/analysis
KW - Female
KW - Self-Management
KW - Aged
KW - Middle Aged
KW - Denmark/epidemiology
KW - Diabetes Mellitus, Type 2/therapy
KW - Cohort Studies
KW - SARS-CoV-2
KW - Diabetes Mellitus, Type 1/therapy
KW - Ambulatory Care Facilities
KW - Surveys and Questionnaires
KW - Pandemics
UR - http://www.scopus.com/inward/record.url?scp=105013163653&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0329394
DO - 10.1371/journal.pone.0329394
M3 - Journal article
C2 - 40794692
SN - 1932-6203
VL - 20
SP - e0329394
JO - PLoS One
JF - PLoS One
IS - 8 August
M1 - e0329394
ER -