Impact of COVID-19 on diabetes care: mixed methods study in an Indigenous area of Guatemala.

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  • Additional Information
    • Source:
      Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
    • Subject Terms:
      COVID-19*/epidemiology ; Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/epidemiology ; Diabetes Mellitus, Type 2*/therapy; Humans ; SARS-CoV-2 ; Glycated Hemoglobin ; Guatemala/epidemiology
    • Abstract:
      Introduction: SARS-CoV-2 has impacted globally the care of chronic diseases. However, direct evidence from certain vulnerable communities, such as Indigenous communities in Latin America, is missing. We use observational data from a health district that primarily serves people of Maya K'iche' ethnicity to examine the care of type 2 diabetes in Guatemala during the pandemic.
      Methods: We used a parallel convergent mixed methods design. Quantitative data (n=142 individuals with diabetes) included glycated haemoglobin (HbA1c), blood pressure, body mass index and questionnaires on diabetes knowledge, self-care and diabetes distress. Quantitative data was collected at two points, at baseline and after COVID restrictions were lifted. For quantitative outcomes, we constructed multilevel mixed effects models with multiple imputation for missing data. Qualitative data included interviews with providers, supervisors and individuals living with diabetes (n=20). We conducted thematic framework analysis using an inductive approach.
      Results: Quantitative data was collected between June 2019 and February 2021, with a median of 487 days between data collection points. HbA1c worsened +0.54% (95% CI, 0.14 to 0.94) and knowledge about diabetes decreased -3.54 points (95% CI, -4.56 to -2.51). Qualitatively, the most important impact of the pandemic was interruption of the regular timing of home visits and peer group meetings which were the standard of care.
      Conclusions: The deterioration of diabetes care was primarily attributed to the loss of regular contact with healthcare workers. The results emphasize the vulnerability of rural and Indigenous populations in Latin America to the suspension of chronic disease care.
      Competing Interests: Competing interests: None declared.
      (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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    • Grant Information:
      K23 HL161271 United States HL NHLBI NIH HHS; P30 DK092926 United States DK NIDDK NIH HHS
    • Contributed Indexing:
      Keywords: COVID-19; Latin America; chronic disease; general diabetes
    • Accession Number:
      0 (Glycated Hemoglobin)
    • Publication Date:
      Date Created: 20240103 Date Completed: 20240105 Latest Revision: 20240425
    • Publication Date:
      20240425
    • Accession Number:
      PMC10773399
    • Accession Number:
      10.1136/bmjopen-2023-079130
    • Accession Number:
      38167279