Australians with type 2 diabetes have adapted mentally and physically to the challenges of pandemic lockdowns but are missing out on specialist appointments, according to new research from the Baker Heart and Diabetes Institute, Melbourne.

A survey of 489 people with T2D  conducted in mid-2020 showed that many had high levels of worry about COVID-19 risks but these concerns did not translate into increased anxiety or depression symptoms, or diabetes distress.

And while people reported a decrease in health-related quality of life during the first wave of the pandemic, they did not reduce key aspects of diabetes self management such as blood glucose monitoring, medication taking or maintaining physical activity.

Younger people seemed to be more affected by the negative impact on quality of life in areas such as leisure activities, feelings about the future, emotional wellbeing, the study found. And while physical activity time was reduced by about 10% overall, the declines in some activities such as gym-style training were offset by increases in fitness-oriented walking, possibly because this was designated one of the four permissible reasons to leave home during lockdown.

The responses from participants enrolled in the Progression of Diabetic Complications (PREDICT) cohort study also showed that 43% cancelled a healthcare appointment during the 2020 survey period,  and 39% avoided new appointments despite perceived need.

Patients were still engaged with their GP, with visits increasing slightly compared to the pre-COVID period, and a high proportion involving telehealth consultations.

Appointment cancellations and avoidance were predominantly reported for endocrinologists and ‘other specialists’ with relatively few cancellations or avoided visits reported for dieticians, diabetes nurse educators and podiatrists.

Overall 43% of clinic outpatient appointments and 61% of hospital/day unit appointments were cancelled, avoided or changed during the 2020 pandemic period. About a third of patients said they avoided ED visits and 16% avoided attendance at a pathology centre despite a perceived need.

The study investigators said the high levels of worry about COVID-19 among people with T2D and negative impacts of the pandemic on their quality of life reinforced the need for ongoing support services to mitigate mental health decline.

And although many people made use of telehealth, “high rates of healthcare appointment avoidance and cancellation should urge practitioners to prioritise patient re-engagement and risk factor monitoring to ensure ongoing quality of care during the pandemic,” they advised.

The findings are published in Diabetic Medicine.