Impact Of Covid-19 And Partial Lockdown On Access To Care, Self-Management And Psychological Well-Being Among People With Diabetes: A Cross-Sectional Study

Background The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, self-care, behavioural, and psychological impact of COVID-19 and partial lockdown amongst diabetes patients in Singapore.Methods We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models.Results Among 301 respondents, 45.2% were women, 67.1% of Chinese ethnicity, 24.2% were aged 40 to 49 years, 68.4% have Type 2 diabetes and 42.2% on oral medications alone. During the pandemic and the lockdown, nearly all respondents were able to receive care safely from the clinics they attend (94%) and obtain their medications and diabetes equipment and supplies (97%) when needed. Respondents reported less frequent engagement in physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (beta = 9.33, P = .043), Type 1 diabetes (beta = 12.92, P = .023), number of diabetes-related comorbidities (beta = 3.16, P = .007) and Indian ethnicity (beta = 6.65, P = .034) were associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (beta = 2.49, P = .014) while ability to reach their doctor despite not going to the clinic is negatively associated with psychological distress (beta = -9.50 P = .002) and barriers to activity (beta = -7.53, P = .007).Conclusion Health services access were minimally affected, but COVID-19 and lockdown had mixed impacts on self-care and management behaviours. Greater clinical care and attention should be provided to people with diabetes with multiple comorbidities and previous mental health disorders during the pandemic and lockdown.