# Persistent glycemic deterioration after the COVID-19 pandemic: A large cohort analysis stratifying by care settings, specialties, and gender disparities in Chengdu, China

## TL;DR

This study found that glycemic control worsened during and after the COVID-19 pandemic, especially in outpatient settings and among older men.

## Contribution

The study reveals persistent glycemic deterioration post-pandemic and identifies vulnerable groups and healthcare settings.

## Key findings

- Median HbA1c levels increased during the pandemic and remained elevated afterward.
- Outpatient settings and critical care units showed the worst glycemic control.
- Older adults and males were most affected by glycemic deterioration.

## Abstract

This study aimed to quantify the sustained impact of the Coronavirus Disease 2019(COVID-19) pandemic on glycemic control across distinct healthcare settings, medical specialties, and demographic groups.

We conducted a retrospective analysis of 274,909 glycated hemoglobin(HbA1c) records from a tertiary hospital in Chengdu,China between 2013 and 2025. Non-parametric tests were used to compare median HbA1c levels across pre-pandemic, pandemic, peak-infection, and post-pandemic phases, stratified by Healthcare Settings, specialty, age, and gender.

Significant deterioration in glycemic control was observed during the pandemic period and sustained thereafter. Median HbA1c increased from 5.9 % (pre-pandemic) to 6.4 % (peak infection), remaining elevated at 6.2 % post-pandemic (p < 0.01). Outpatient settings demonstrated the poorest glycemic control (median 6.4 %). The most pronounced deteriorations occurred in critical care unit (ICU: Δ + 3.0 %) and surgical departments (Δ + 0.7 %), while Endocrinology maintained better outcomes (Δ-0.3 %). Older adults (≥76 years, Δ + 0.6 %) and male patients showed greatest vulnerability to glycemic deterioration.

The COVID-19 pandemic resulted in persistent glycemic deterioration, particularly affecting outpatient management, acute care settings, and vulnerable demographic groups. These findings highlight critical gaps in diabetes care resilience and underscore the need for targeted interventions in high-risk settings and strengthened support systems for susceptible populations.

•Persistent post-pandemic deterioration in glycemic control was observed.•Outpatient settings demonstrated the poorest glycemic control during the pandemic.•Acute and critical care settings experienced the most severe glycemic deterioration.•Specialized diabetes care demonstrated resilient glycemic outcomes.•Older adults and male patients were most vulnerable to glycemic deterioration.

Persistent post-pandemic deterioration in glycemic control was observed.

Outpatient settings demonstrated the poorest glycemic control during the pandemic.

Acute and critical care settings experienced the most severe glycemic deterioration.

Specialized diabetes care demonstrated resilient glycemic outcomes.

Older adults and male patients were most vulnerable to glycemic deterioration.