Changes in diabetes screening and exercise during the COVID-19 pandemic in adults with prediabetes

Abstract

Aims: To evaluate changes in type 2 diabetes mellitus (T2DM) screening and exercise during the COVID-19 shelter-in-place, and whether Medicaid patients and racial/ethnic minoritized groups were disproportionally affected.

Methods: Retrospective cohort study of 578,585 adults with prediabetes aged ≥ 18-89 years with BMI ≥ 25 (≥23 if Asian) at Kaiser Permanente Northern California from January 2019 to December 2021. We used separate interrupted time-series analyses of aggregated weekly T2DM screening rates, or mean exercise minutes, to evaluate any decrease associated with the shelter-in-place (March 19, 2020, to June 1, 2020). Analyses were performed in 2023-2024.

Results: Before Covid, 121/10,000 patients/week were screened for T2DM, and patients exercised 107 min/week. Initially, screening dropped to near zero (by ∼ 96 %) followed by a slow increase of 7.4 (95 % CI: 2.4-12.4, p-value 0.004)/10,000 patients/week during the shelter-in-place. Similarly, exercise decreased initially by 37 (29-45, p-value < 0.001) minutes/week, followed by a slow increase of 3.5 (1.7-5.4, p-value < 0.001) minutes/week during the shelter-in-place. These patterns were similar across racial/ethnic groups; however, Medicaid patients took 1.5 years to resume baseline exercise levels.

Conclusions: The shelter-in-place was associated with an abrupt decrease in T2DM screening and exercise among adults with prediabetes. Future mandates should support high-risk populations, especially Medicaid, to maintain T2DM screening and exercise to prevent T2DM progression.

Keywords: COVID-19 pandemic; Exercise; Medicaid; Race and ethnicity disparities; Shelter-in-place mandate; Type 2 diabetes mellitus screening.