Did People with Diabetes Face Care Shortages during the Coronavirus Pandemic? A Study Shows a Striking Trend

In a recently published study, the Institute for Health Services Research and Health Economics of the DZD partner German Diabetes Center (DDZ) in Dusseldorf found evidence of a shortage of care for diabetes patients during the coronavirus pandemic.

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The aim of the study was to analyze the hospitalization and mortality rates of people with and without diabetes in Germany during the COVID-19 pandemic year 2020 in comparison with the years 2017 to 2019. Using anonymized data from 3.2 million people insured with AOK Rheinland/Hamburg, the team led by Professor Andrea Icks, director of the Institute for Health Services Research and Health Economics at Heinrich Heine University Düsseldorf and the German Diabetes Center, was able to generate the first validated data showing that there were significant differences evident in the health outcomes of people with diabetes in the first year of the pandemic compared to the previous years.

"It was often reported, both in Germany and internationally, that people with diabetes made less use of healthcare services during the COVID-19 pandemic and the availability of medical care for diabetes was partially limited,” reports Prof. Icks. “There was and is very little empirical data on this topic that can reliably support this statement. Therefore, we wanted to examine these assumptions using a major population-based study. To achieve this, we used the health insurance data of more than three million insured persons”.

The Study Findings Show an Increase in Leg Amputations during the First Year of the Coronavirus Pandemic
Using established algorithms, the research group estimated the age-and-gender standardized mortality rates associated with general hospital stays and hospital stays on account of coronary heart disease, acute heart attack, stroke, diabetic foot syndrome, and leg amputations and amputations below the ankle for people with and without diabetes. The rates for 2020 were predicted using Poisson regression and subsequently compared with the rates observed in the data of the insured persons.

The Findings Showed that some of the Predictions Diverged Notably from what was Observed:

  • The observed general hospital stays during 2020 of people with diabetes were significantly lower than predicted.
  • There was a striking decrease in hospital stays associated with coronary heart disease and acute heart attack.
  • There was also a notable reduction in hospital stays associated with diabetic foot syndrome.
  • In contrast, hospital stays associated with leg amputations were significantly higher than predicted.

“The fact that there was less treatment of foot wounds but more leg amputations may be indicative of seeking medical care being sought too late,” warns Prof. Icks. There can be any number of reasons for this: fear of COVID-19 infection and the corresponding avoidance of doctor’s appointments or hospital admission, inadequate self-management of diabetes stemming from demotivation, or social distancing coupled with a lack of or limited medical support. However, the findings are limited by the fact that they are based on data from a regional statutory health insurance provider. “A nationwide in-depth study on this topic is absolutely essential,” urges Andrea Icks.

Original publication:
Narres M., ..., Icks A..Hospitalisation rate and mortality among people with and without diabetes during the COVID-19 pandemic year 2020, European Journal of Epidemiology (2022) 37:587-590;