{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:42:44Z","timestamp":1772160164253,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005847","name":"Health and Medical Research Fund","doi-asserted-by":"publisher","award":["COVID19F08"],"award-info":[{"award-number":["COVID19F08"]}],"id":[{"id":"10.13039\/501100005847","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Reduced specialist outpatient clinic (SOPC) services during COVID\u201019 waves may have increased the risk of mortality and complications in patients with diabetes mellitus (DM). Evidence on whether alternative modes of service have mitigated these risks is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this population\u2010based, retrospective cohort study in Hong Kong, we included patients with DM between 2010 and 2019 and had internal medicine SOPC visits in 2019. We identified modes of care (SOPC, primary care clinics and drug\u2010refill service) of these patients in 2020 and followed them from January 2021 to June 2024. Cox proportional hazards models were used to estimate risks of all\u2010cause mortality and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 96\u2009372 patients, SOPC follow\u2010up disruptions in 2020 were associated with a higher risk of all\u2010cause mortality (hazard ratio [HR] 1.20, 95% CI 1.12\u20131.29) and cardiovascular diseases (CVD) incidence (HR 1.12, 95% CI 1.05\u20131.20). Among those affected by SOPC follow\u2010up disruptions in 2020, patients who had attended primary care clinics in 2020 had a lower risk of all\u2010cause mortality (HR 0.72, 95% CI 0.60\u20130.87) and CVD (HR 0.84, 95% CI 0.72\u20130.99) than those without any primary care clinic attendance visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SOPC service disruption was associated with increased risk of mortality and CVD among patients with DM. Primary care clinic service could be a beneficial alternative mode of service to attenuate the excessive risk. These findings support a policy that follow\u2010up at primary care clinics should be provided for patients with DM when SOPC service is disrupted in future public health crises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70069","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:52:55Z","timestamp":1756374775000},"page":"6615-6623","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Disrupted specialist outpatient services and alternative modes of service for patients with diabetes mellitus: A population\u2010based, retrospective cohort study in Hong Kong"],"prefix":"10.1111","volume":"27","author":[{"given":"Yuk Kam","family":"Yau","sequence":"first","affiliation":[{"name":"Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong 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Kai","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivy Lynn","family":"Mak","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chak Sing","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian Chi Kei","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine The University of Hong 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