{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:06:19Z","timestamp":1788307579469,"version":"build-2803163510"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes for Health Research","doi-asserted-by":"crossref","award":["W11-179885"],"award-info":[{"award-number":["W11-179885"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Canada Research Chair (Tier 2) in Ethical Complexity in Primary Care"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In Canada, primary care manages most diabetes care. The COVID-19 pandemic disrupted primary care, reducing access to care and monitoring.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We aim to describe changes in diabetes monitoring during the first 21 months of the pandemic, patients\u2019 experiences with these changes, and impact on HbA1c and blood pressure (BP) control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a two-phase mixed methods study: (i) A retrospective pre-post cohort study using de-identified electronic medical record data to compare HbA1c and BP measurement frequency and results in diabetic patients prepandemic (22 June 2018 to 12 March 2020) and during the pandemic (13 March 2020 to 3 December 2021); (ii) A qualitative descriptive analysis using semistructured interviews to understand patient experiences navigating diabetes care during the pandemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The cohort included 84\u00a0617 patients with validated diabetes case definition. Proportion of patients with &amp;lt;1 HbA1c test increased by 10% during the pandemic. For those with \u22651 test, mean HbA1c remained unchanged [mean (SD) HbA1cPre: 7.2 (1.3); HbA1cDuring: 7.2 (1.3); P\u2005=\u2005.51]. Proportion of patients with &amp;lt;1 BP measurement increased by 23%. For those with \u22651 measurement, mean BP remained clinically similar [mean (SD) sBPPre: 131.8 (13.7); sBPDuring: 132.9 (15.2); P\u2005&amp;lt;\u2005.01. Mean dBPPre: 74.9 (8.6); dBPDuring: 75.1 (9.1); P\u2005=\u2005.63]. Nineteen participants were interviewed, discussing virtual care, challenges with self-monitoring, and self-management strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Mean HbA1c and BP values remained clinically stable during the pandemic despite reductions in monitoring frequency, likely due to continuity of care and patient self-management. Future research should evaluate a de-intensified frequency of diabetes monitoring and address care gaps.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/fampra\/cmaf027","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T08:02:48Z","timestamp":1749801768000},"source":"Crossref","is-referenced-by-count":3,"title":["Primary care insights on the management of diabetes: results from a mixed method study of care changes and impacts during the COVID-19 pandemic"],"prefix":"10.1093","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7638-8190","authenticated-orcid":false,"given":"Karla","family":"Freeman","sequence":"first","affiliation":[{"name":"Department of Family Medicine, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2853-6881","authenticated-orcid":false,"given":"Shuaib","family":"Hafid","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2149-9376","authenticated-orcid":false,"given":"Dee","family":"Mangin","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8 ,","place":["Canada"]},{"name":"Department of General Practice (Primary Care and Clinical Simulation), University of Otago , 362 Leith St, North Dunedin, Dunedin 9016 ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Carruthers","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Vanstone","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris","family":"Aubrey-Bassler","sequence":"additional","affiliation":[{"name":"Primary Healthcare Research Unit, Memorial University of Newfoundland , 230 Elizabeth Ave, St. John's, A1B 1T5 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Lawson","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Th\u00e9r\u00e8se","family":"Lussier","sequence":"additional","affiliation":[{"name":"D\u00e9partement de M\u00e9decine de famille et de M\u00e9decine d\u2019urgence, Universit\u00e9 de Montr\u00e9al , 2900 Bd \u00c9douard-Montpetit, Montr\u00e9al, QC H3T 1J4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8 ,","place":["Canada"]},{"name":"Department of Epidemiology and Biostatistics, Western University , 1151 Richmond St, London, ON N6A 3K7 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Drummond","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Alberta , 116 St & 85 Ave, Edmonton, AB T6G 2R3 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Queenan","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Queen\u2019s University , 99 University Ave, Kingston, ON K7L 3N6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8127-5492","authenticated-orcid":false,"given":"Michelle","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"2025061304024282300_CIT0001","author":"Public Health Agency of Canada","year":"2023","journal-title":"Canadian Chronic Disease Surveillance System (CCDSS): Use of Health Services for Mood and Anxiety Disorders (Annual), Age-Standardized Prevalence, Percent, Age 1 Year and Older, Canada"},{"key":"2025061304024282300_CIT0002","author":"Public Health Agency of Canada","year":"2023","journal-title":"Canadian Chronic Disease Surveillance System (CCDSS), Data Tool 2000-2020"},{"key":"2025061304024282300_CIT0003","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.jcjd.2013.02.055","article-title":"Type 2 diabetes mellitus management in Canada: is it improving","volume":"37","author":"Leiter","year":"2013","journal-title":"Can J Diabetes"},{"key":"2025061304024282300_CIT0004","doi-asserted-by":"publisher","first-page":"S27","DOI":"10.1016\/j.jcjd.2017.10.005","article-title":"Organization of diabetes care","volume":"42","author":"Clement","year":"2018","journal-title":"Can J Diabetes"},{"key":"2025061304024282300_CIT0005","first-page":"745","article-title":"Managing type 2 diabetes in primary care during COVID-19","volume":"66","author":"Kiran","year":"2020","journal-title":"Can Fam Physician"},{"key":"2025061304024282300_CIT0006","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1111\/j.1468-0009.2005.00409.x","article-title":"Contribution of primary care to health systems and health","volume":"83","author":"Starfield","year":"2005","journal-title":"Milbank Q"},{"key":"2025061304024282300_CIT0007","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s12875-019-0932-9","article-title":"Interprofessional collaboration in diabetes care: perceptions of family physicians practicing in or not in a primary health care team","volume":"20","author":"Szafran","year":"2019","journal-title":"BMC Fam Pract"},{"key":"2025061304024282300_CIT0008","doi-asserted-by":"publisher","first-page":"401","DOI":"10.2337\/cd21-0119","article-title":"Role of primary care clinicians in the management of patients with type 2 diabetes and cardiorenal diseases","volume":"40","author":"Kushner","year":"2022","journal-title":"Clin Diabetes"},{"key":"2025061304024282300_CIT0009","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s12875-021-01493-x","article-title":"Effects of continuity of care on health outcomes among patients with diabetes mellitus and\/or hypertension: a systematic review","volume":"22","author":"Chan","year":"2021","journal-title":"BMC Fam Pract"},{"key":"2025061304024282300_CIT0010","doi-asserted-by":"publisher","first-page":"e084608","DOI":"10.1136\/bmjopen-2024-084608","article-title":"Describing primary care patterns before and during the COVID-19 pandemic across Canada: a quasi-experimental pre\u2013post design cohort study using national practice-based research network data","volume":"14","author":"Hafid","year":"2024","journal-title":"BMJ Open"},{"key":"2025061304024282300_CIT0011","doi-asserted-by":"publisher","first-page":"e0255992","DOI":"10.1371\/journal.pone.0255992","article-title":"Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada","volume":"16","author":"Stephenson","year":"2021","journal-title":"PLoS One"},{"key":"2025061304024282300_CIT0012","doi-asserted-by":"publisher","first-page":"E200","DOI":"10.1503\/cmaj.202303","article-title":"Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada","volume":"193","author":"Glazier","year":"2021","journal-title":"CMAJ"},{"key":"2025061304024282300_CIT0013","doi-asserted-by":"publisher","first-page":"e059130","DOI":"10.1136\/bmjopen-2021-059130","article-title":"Changes in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID)","volume":"12","author":"Tu","year":"2022","journal-title":"BMJ Open"},{"key":"2025061304024282300_CIT0014","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.jcjd.2023.01.003","article-title":"Impact of the COVID-19 pandemic on adults with type 2 diabetes care and clinical parameters in a primary care setting in Ontario, Canada: a cross-sectional study","volume":"47","author":"Cheng","year":"2023","journal-title":"Can J Diabetes"},{"key":"2025061304024282300_CIT0015","doi-asserted-by":"publisher","first-page":"e49131","DOI":"10.2196\/49131","article-title":"Effects of the COVID-19 pandemic on primary health care for chronic conditions in Canada: protocol for a retrospective pre-post study using national practice-based research network data","volume":"12","author":"Howard","year":"2023","journal-title":"JMIR Res Protoc"},{"key":"2025061304024282300_CIT0016","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1370\/afm.1644","article-title":"Validating the 8 CPCSSN case definitions for chronic disease surveillance in a primary care database of electronic health records","volume":"12","author":"Williamson","year":"2014","journal-title":"Ann Fam Med"},{"key":"2025061304024282300_CIT0017","author":"Canadian Institute for Health Information","year":"2025","journal-title":"Canadian COVID-19 Intervention Timeline"},{"key":"2025061304024282300_CIT0018","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1016\/j.jcjd.2017.10.030","article-title":"Targets for Glycemic Control","volume":"42","author":"Imran","year":"2018","journal-title":"Can J Diabetes"},{"key":"2025061304024282300_CIT0019","doi-asserted-by":"publisher","first-page":"bjgpopen20X101020","DOI":"10.3399\/bjgpopen20X101020","article-title":"Exploring patients\u2019 and clinicians\u2019 experiences of video consultations in primary care: a systematic scoping review","volume":"4","author":"Thiyagarajan","year":"2020","journal-title":"BJGP Open"},{"key":"2025061304024282300_CIT0020","doi-asserted-by":"publisher","first-page":"e2136405","DOI":"10.1001\/jamanetworkopen.2021.36405","article-title":"Assessment of patient preferences for telehealth in post\u2013COVID-19 pandemic health care","volume":"4","author":"Predmore","year":"2021","journal-title":"JAMA Network Open"},{"key":"2025061304024282300_CIT0021","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.mayocpiqo.2021.01.006","article-title":"Patient work and treatment burden in type 2 diabetes: a mixed-methods study","volume":"5","author":"Spencer-Bonilla","year":"2021","journal-title":"Mayo Clinic Proceed"},{"key":"2025061304024282300_CIT0022","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1016\/j.cjca.2020.02.086","article-title":"Hypertension Canada\u2019s 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children","volume":"36","author":"Rabi","year":"2020","journal-title":"Can J Cardiol"},{"key":"2025061304024282300_CIT0023","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1136\/bmj.37967.374063.EE","article-title":"Randomised equivalence trial comparing three month and six month follow up of patients with hypertension by family practitioners","volume":"328","author":"Birtwhistle","year":"2004","journal-title":"BMJ (Clin Res Ed)"},{"key":"2025061304024282300_CIT0024","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.diabres.2017.11.013","article-title":"HbA1c monitoring interval in patients on treatment for stable type 2 diabetes. A ten-year retrospective, open cohort study","volume":"135","author":"Ohde","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"key":"2025061304024282300_CIT0025","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/j.jcjd.2022.02.010","article-title":"Potential overtreatment and overtesting among older adults with type 2 diabetes across Canada: an observational, retrospective cohort study","volume":"46","author":"Gudi","year":"2022","journal-title":"Can J Diabetes"},{"key":"2025061304024282300_CIT0026","doi-asserted-by":"publisher","first-page":"h6138","DOI":"10.1136\/bmj.h6138","article-title":"HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study","volume":"351","author":"McCoy","year":"2015","journal-title":"Bmj"},{"key":"2025061304024282300_CIT0027","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1016\/j.jamda.2015.03.013","article-title":"Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research","volume":"16","author":"Fabbri","year":"2015","journal-title":"J Am Med Dir Assoc"},{"key":"2025061304024282300_CIT0028","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1111\/hex.12046","article-title":"Burden of treatment for chronic illness: a concept analysis and review of the literature","volume":"18","author":"Sav","year":"2015","journal-title":"Health Expectations"},{"key":"2025061304024282300_CIT0029","doi-asserted-by":"publisher","first-page":"432892","DOI":"10.6064\/2012\/432892","article-title":"The impact of primary care: a focused review","volume":"2012","author":"Shi","year":"2012","journal-title":"Scientifica"},{"key":"2025061304024282300_CIT0030","first-page":"1","article-title":"Brief on primary care part 2: factors affecting primary care capacity in Ontario for pandemic response and recovery","volume":"3","author":"Mangin","year":"2022","journal-title":"Sci Briefs Ontario COVID-19 Sci Advisory Table"},{"key":"2025061304024282300_CIT0031","doi-asserted-by":"publisher","first-page":"e224163","DOI":"10.1001\/jamahealthforum.2022.4163","article-title":"Trends in clinician burnout with associated mitigating and aggravating factors during the COVID-19 pandemic","volume":"3","author":"Linzer","year":"2022","journal-title":"JAMA Health Forum"},{"key":"2025061304024282300_CIT0032","author":"Larocque","year":"2022"},{"key":"2025061304024282300_CIT0033","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1370\/afm.2865","article-title":"Family physicians stopping practice during the COVID-19 pandemic in Ontario, Canada","volume":"20","author":"Kiran","year":"2022","journal-title":"Ann Fam Med"},{"key":"2025061304024282300_CIT0034","doi-asserted-by":"publisher","article-title":"Stressed out and burned out: the global primary care crisis \u2014 findings from the 2022 international health policy survey of primary care physicians 2022","author":"Gunja","DOI":"10.26099\/j2ag-mx88"},{"key":"2025061304024282300_CIT0035","author":"Raizman","year":"2022"},{"key":"2025061304024282300_CIT0036","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1016\/j.cjco.2023.09.005","article-title":"Assessing primary care blood pressure documentation for hypertension management during the COVID-19 pandemic by patient and provider groups","volume":"5","author":"Senthinathan","year":"2023","journal-title":"CJC Open"}],"container-title":["Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/42\/4\/cmaf027\/63481515\/cmaf027.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/42\/4\/cmaf027\/63481515\/cmaf027.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T08:02:49Z","timestamp":1749801769000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/fampra\/article\/doi\/10.1093\/fampra\/cmaf027\/8161329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":36,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,6,4]]}},"URL":"https:\/\/doi.org\/10.1093\/fampra\/cmaf027","relation":{},"ISSN":["1460-2229"],"issn-type":[{"value":"1460-2229","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,6,4]]},"article-number":"cmaf027"}}