Compare diabetes care patterns by primary care accessibility during the COVID-19 pandemic.

Abstract

Purpose: The COVID-19 pandemic disrupted primary care delivery and may have exacerbated disparities in chronic disease management, particularly for diabetes mellitus. This study sought to investigate how living in areas with low access to primary care providers (PCP) affected the delivery of diabetes care during the pandemic.

Methods: This is a retrospective longitudinal study using the Panel 24 of the Medical Expenditure Panel Survey data merged with the 2019 County Health Rankings data to classify areas by PCP availability (low vs. high). Dependent variables included measures of care processes (e.g., number of HbA1c tests), quality (e.g., diet modification) and outcomes (e.g., eye complications). Multivariable models were adjusted for demographics, insurance status and COVID-19 diagnosis.

Findings: HbA1c testing, foot examinations and retinal examinations decreased during the pandemic for both groups, with much more pronounced declines in low PCP density areas. The largest change occurred in the frequency of attending group classes, dropping nearly 80% in low PCP areas. Individuals in low PCP areas were more likely to initiate oral diabetes medications (as opposed to insulin) compared with those in high PCP areas (0.84% vs. 0.28%, p = 0.015). Older age was associated with new diabetes (HR = 1.05) and new kidney disease (HR = 1.04), but less likely to start diet modification (HR = 0.99). Being female (HR = 0.69) and non-Hispanic whites (HR = 0.60) were associated with a lower likelihood of diabetes incidents.

Conclusions: These findings highlight the importance of preparing public health responses for future events that limit access to routine care, particularly for individuals with or at risk of diabetes. Strengthening both in-person and virtual primary care services is critical to reducing gaps in chronic disease management and to supporting ongoing PCP follow-up.