Diabetes Management during the COVID-19 pandemic: A Study on Contributory Health Service Scheme Beneficiaries from Mumbai, India

Background: The COVID-19 pandemic significantly disrupted healthcare utilisation, particularly for individuals with chronic conditions like diabetes. India, ranked third globally in confirmed COVID-19 cases, imposed strict lockdowns from March 24, 2020. This study aims to understand diabetes management during the pandemic within the framework of a uniform contributory healthcare scheme. Data and Methods: This study analyses healthcare utilisation patterns among 653 diabetes patients from a retrospective cohort of 835 individuals with Type 2 Diabetes based in Mumbai, India. Data spanning pre-pandemic and pandemic phases are compared across various healthcare usages. Trends in glycemic control during COVID-19 are also evaluated relative to pre-COVID levels. Results: We identified discernible trends in healthcare usage: there was a notable decrease during the initial wave of the pandemic, a subsequent rise, and followed by a decrease during the second wave. This trend was evident across various healthcare services, including outpatient department (OPD) visits, inpatient department (IPD) admissions, laboratory tests, and pharmaceutical purchases. Healthcare use remained higher among individuals with comorbidities throughout the pandemic period. Individuals aged 75 and above did not show the same level of recovery in OPD visits during the intermittent period as younger age groups, suggesting increased vulnerability and avoidance of in-person care among older adults. A gendered pattern was also observed in lab test utilisation: among women, testing rates halved during the initial phase, recovered to 80% during the intermittent period, and declined again during the second wave. In contrast, among men, lab test usage remained suppressed throughout the pandemic period. The 45–59 and 60-74 age groups showed the most substantial recovery in lab test rates during the intermittent period. Additionally, hospitalisation rates among women and individuals aged 60–74 exceeded pre-pandemic levels during this phase, suggesting delayed care-seeking or a rise in severe cases. Despite these shifts in healthcare utilisation, the overall average values of HbA1c and fasting plasma glucose (FPG) remained relatively stable in men and the oldest age group (75 and above). An exception was noted among women, who exhibited more variability in glycaemic indicators. Importantly, there was no strong correlation between the frequency of HbA1c testing or OPD visits with the corresponding HbA1c values. However, a significant association was found between HbA1c values recorded prior to the pandemic and those during successive waves, indicating that individuals with poor glycaemic control before the pandemic continued to face challenges during it.