Medication Access Critical for Type 2 Diabetes Patients During Pandemic

Thanks to pharmacies, most patients with type 2 diabetes did all right during the COVID-19 pandemic. That’s according to Harvard Medical School researchers who determined that, while office visits and testing were disrupted, patients continued to have access to their medications, which was critical to their health. Here is more information.

BOSTON – Despite disruptions during the COVID-19 pandemic, type 2 diabetes fared all right, primarily because pharmacies made sure they got their medications.

That’s according to a recent article in JAMA Internal Medicine. Harvard Medical School-led researchers point out that concerns about lapses in diabetes management and glycemic control were raised during the pandemic because of sharp drops in outpatient visits and laboratory testing early in the pandemic.

Using a national cohort of nearly 1.4 million type 2 diabetes patients for each year, the study team compared weekly rates of diabetes-related outpatient visits, screening tests, medication fills, and patients’ hemoglobin A1c levels in 2020 compared to 2019 before the pandemic.

“While diabetes-related outpatient visits and testing fell during the pandemic, we observed no evidence of a negative association with medication fills or glycemic control,” the authors write. “One explanation for these patterns could be the small increase in medication fill rates during the pandemic that may have protected against any disruptions in diabetes self-management during the pandemic and hence staved off detrimental effects on glycemic control. Mail-order pharmacies and pharmacy delivery services may have been key during the pandemic in ensuring patients receive their medications. Together, these would be consistent with diabetes disaster preparedness guidelines, which emphasize prioritizing access to medications over access to health care professionals during an emergency.”

The study used de-identified claims from OptumLabs Data Warehouse to create 2 cohorts of adults with type 2 diabetes and continuous enrollment in commercial or Medicare Advantage health plans

Based on analysis of 1.35 patients in 2019 and 1.36 in 2020, with similar baseline characteristics, researchers point out that 0.3% of cohort had 1 or more telemedicine visits in 2019, compared with 29.1% of the 2020 cohort during the pandemic period.

While during the prepandemic period, no clinically meaningful difference between the cohorts across all outcome measures was detected, early in the pandemic period, large reductions in visits and testing occurred. Those rebounded to near-baseline levels by week 48, according to the study.

Across the entire pandemic period, adjusted use was lower in 2020 compared with 2019 for:

  • outpatient visits (85.0% vs 87.3% of patients in 2020 and 2019 cohorts with ≥1 outpatient visit during pandemic period; relative percent change −2.6%),
  • HbA1c testing (76.5% vs 81.8%; −6.5%),
  • retinopathy testing (5.6% vs 6.9%; −18.8%), and
  • nephropathy testing (40.1% vs 43.9%; −8.5%).

“In contrast, medication fill rates were similar during the pandemic period of 2020 as compared with 2019 (64.2% vs 62.2%; 3.6%). Levels of HbA1c were nearly identical during the pandemic period of 2020 compared with 2019 (7.16% vs 7.14%; 0.3%),” the authors advise. “Due to sample size, all comparisons between 2020 and 2019 were statistically significant.”

The study team concludes, “The unprecedented increase in telemedicine visits we observe during the pandemic, although unable to overcome the overall decrease in visits, may have prevented substantive disruptions in medication prescribing. Our findings also emphasize that there is not a direct relationship between visit frequency and glycemic control. Limitations of our findings include that the results may not generalize to other populations such as those with Medicaid insurance or the uninsured.”

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