Enforced inactivity in the elderly and diabetes risk: initial estimates of the burden of an unintended consequence of COVID-19 lockdown
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Abstract
Background
Older adults and those with underlying health conditions were advised to stay at home to help reduce the spread of COVID-19 however little advice on regular physical activity was given to those at risk. We modelled the effects of enforced inactivity on diabetes burden using published evidence.
Methods
Using Health Survey for England data, we estimated the prevalence of pre-diabetes and physical activity in adults aged 70 and older. The number of new diabetes cases directly attributed to lockdown were calculated using population attributable risk. Unit cost estimates of the additional burden on primary care and the cost of complications to secondary care were taken from the literature.
Results
From 9 million older (≥70yrs) people living in England, 2.1 million could be defined as pre-diabetic (glycated haemoglobin 42<48 mmol/mol). The estimated population attributable fraction (0.281) (assuming relative risk of diabetes from inactivity=3.3, 40% physically active) would give rise to 392,948 new cases of diabetes which we argue are directly attributed to a prolonged period of lockdown. We estimate that the cost of screening and testing these patients in primary care (£35m), their subsequent treatment and management (£229m), and complications (£909m) would equate to an additional £1.17bn to the health care system.
Conclusions
Inactivity related to lockdown in previously active older adults may contribute up to £1.17b in additional healthcare costs through a potential increase in diabetes. Clear advice about the importance of physical activity may reduce this potential economic burden during global pandemics.
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SciScore for 10.1101/2020.06.06.20124065: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Assumptions and limitations: This study makes several assumptions. The first assumption is that most adults over 70 years have reduced or even stopped exercise during the lockdown. Whilst some have found ways to exercise safely outdoors, emerging data has found that many either have limited access to open spaces or are concerned about …
SciScore for 10.1101/2020.06.06.20124065: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Assumptions and limitations: This study makes several assumptions. The first assumption is that most adults over 70 years have reduced or even stopped exercise during the lockdown. Whilst some have found ways to exercise safely outdoors, emerging data has found that many either have limited access to open spaces or are concerned about venturing outside of the home where they have a higher chance of encountering the coronavirus.(1) The second assumption is that inactivity as a result of lockdown will last for at least 12 weeks, if not longer, and that this is sufficient time to observe adverse physiological effects of inactivity on glycaemic control. Although there are currently cautious moves to allow people more opportunities to leave home,(36) it is likely that older adults will be advised to remain at home for longer than those of working age. When restrictions are eventually lifted, it is likely that many of those over 70 will remain cautious about going outside to exercise(36) and thus the effects of lockdown on physical activity in this group may persist beyond the formal end of lockdown regulations. Alongside physical activity,(34) a healthy diet is key to reducing the risk of developing diabetes, and most diabetes prevention trials include dietary intervention in combination with structured exercise and weight loss.(14–17) Our risk estimates of inactivity on diabetes are drawn from such trials, thus it is difficult to tease apart the effects of diet and weight loss fr...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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