Disruption and recovery of type 2 diabetes screening during the COVID-19 pandemic: a population-based interrupted time-series analysis in Ontario, Canada

Introduction — The pandemic disrupted routine healthcare services, including preventive screening for diabetes. We examined the impact of the pandemic on diabetes screening rates and recovery patterns in a universal healthcare setting.

Methods — We conducted a time-series analysis using linked administrative health care and laboratory data from Ontario, Canada to compare expected versus observed monthly diabetes screening rates during the period from March 2020 to March 2023 in the non-diabetes population overall and among subgroups defined by age, sex, and neighborhood socioeconomic status. Monthly expected screening rates were predicted for the same period based on patterns observed from March 2016 to March 2020.

Results — Overall, the eligible, non-diabetes population was 9,359,851 in Mar 2016 and 9,894,353 in Mar 2023. Diabetes screening rates declined sharply by 70.1% during the initial lockdown period in April 2020 compared to February 2020 (1.55 vs. 4.47 per 100, -2.92 per 100) with a gradual increase to pre-pandemic levels. As well, 24.5% fewer individuals were screened during the pandemic period versus pre-pandemic levels. While the overall patterns were consistent by sex, the rate of recovery was greater among women (6.42 vs 4.85 per 100, -1.57 per 100) in March 2023. As well, screening recovery rates appeared to be two to three-fold higher among adults aged 50+. Findings were consistent across income groups with slightly higher recovery rates for those living in higher income communities.

Conclusions — The observed sudden decline in diabetes screening may lead to delays in prediabetes and diabetes diagnosis, resulting in missed opportunities for diabetes prevention and early management.