ADA Survey Highlights COVID-19’s Impact on Americans With Diabetes

January 11, 2021
Gianna Melillo

Gianna is an associate editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.

A new American Diabetes Association (ADA) survey highlights how the coronavirus disease 2019 (COVID-19) pandemic took a toll on the population with diabetes, which is one of the most prevalent preexisting conditions in America.

A survey of 2595 individuals with diabetes conducted by the American Diabetes Association (ADA) and Thrivable found that 43% of respondents delayed seeking routine care during the coronavirus disease 2019 (COVID-19) pandemic, with more than 50% of those respondents citing fear of exposure to COVID-19 as a deterrent.

Individuals with diabetes are more likely to experience severe COVID-19 symptoms, and complications in immune dysfunction and inflammation have occurred in this patient population. CDC data from October 2020 showed that diabetes was recorded as an underlying condition for approximately 4 in 10 patients who died from COVID-19. Among Americans younger than 65 years who died, around half had diabetes, STAT News reports.

However, according to the ADA, if an individual’s diabetes is well managed, the risk of getting very sick with COVID-19 is likely to be lower. Diabetes is one of the most prevalent preexisting conditions in the country, with more than 34.2 million Americans, including 14.3 million seniors, living with the disease in 2018.

To assess how the pandemic has affected Americans with diabetes when it comes to disease management and care, researchers conducted a multiple-choice survey between December 7 and December 14, 2020. The majority of respondents (53%) had type 2 diabetes (T2D), whereas 47% had type 1 diabetes (T1D). All 50 US states were represented in the sample and 69% of respondents were female.

Financial strain was a common theme in patients’ replies:

  • 9% of respondents said they could not afford medical care during the pandemic.
  • 1 in 5 people said they had foregone or put off getting a pump or continuous glucose monitor (CGM), while for half of them, it was due to financial strain.
  • 15% of people with diabetes who rely on management technologies like pumps or CGMs have delayed refilling needed supplies during the pandemic; for 70% of them, it was due to financial strain.
  • 12% of people with diabetes have experienced a disruption in insurance coverage since the start of the pandemic; of those who lost coverage in the pandemic’s wake, 50% could not regain coverage.

Results also showed that the pandemic disrupted access to healthy food for more than 1 in 4 people with diabetes. Food insecurity disproportionately impacted individuals with lower reported annual household incomes, and nearly 1 in 5 respondents reported needing to rely on nutrition assistance programs in the wake of COVID-19.

“Of those relying on nutrition assistance programs during the public health emergency, nearly half say the foods they’re getting are not good for their diabetes,” the survey found. Furthermore, nearly 1 in 5 people with diabetes reported they needed to choose between buying food or diabetes management medications and supplies during the crisis.

Despite the setbacks faced by the population during the pandemic, many patients with diabetes appeared to benefit from increased access and use of telehealth services. The survey found:

  1. 73% of people with diabetes have used telehealth services during the pandemic, compared to just 11% prior to COVID-19.
  2. Of those who have utilized telehealth, 40% report that it has made it easier to manage their diabetes, compared with 37% who reported no change.
  3. 36% say they plan to continue seeking health care remotely after the pandemic.

As individuals with diabetes are at a higher risk of suffering COVID-19 complications, patients may also be eligible to receive vaccines prior to the general public. However, only 37% of those with diabetes reported they plan to get a vaccine immediately when it becomes available, compared with just 27% of the general US population.

Mixed messaging from the CDC on vaccine distribution priority groups may be to blame in part for this low rate. Currently, the CDC ranks those with T2D higher than those with T1D for COVID-19 vaccine prioritization, although research has shown that individuals with T1D are at just as high a risk of dying from COVID-19 as those with T2D, according to STAT News. CDC guidelines state that those with T2D ought to be vaccinated in phase 1C of distribution, while those with T1D are in phase 2. However, the recommendations may change depending on new research while states are free to create their own priority lists.