A Temporal Analysis of the Impact of COVID-19 on Diabetes Epidemiology in KwaZulu-Natal, South Africa

Background and study aim: The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about its impact on chronic disease management, including diabetes. This study assessed the pandemic’s effects on diabetes incidence, healthcare utilization, glycaemic control, and diabetes-related amputations in KwaZulu-Natal (KZN), South Africa. We aimed to analyse trends in diabetes incidence, screening, healthcare engagement, glycaemic control, and amputations across pre-pandemic, pandemic, and post-pandemic periods in KZN, while identifying gaps and challenges in diabetes care recovery.Patients and Methods: A retrospective analysis of provincial health data from public sector facilities was conducted, comparing pre-pandemic (2018–2019), pandemic (2020–2021), and post-pandemic (2022–2023) periods. Indicators included diabetes incidence (per 100,000 population), screening volume and yield, clinic visits, HbA1c <7% rates, and amputation rates. Paired t-tests and Wilcoxon signed-rank tests assessed significance.Results: Diabetes incidence rose from 526.9 (pre) to 570.0 during COVID (+8.2%) and surged to 1104.2 post-pandemic (+93.7% vs COVID). Reported incidence underestimated true rates, with undercounts rising from 46.9% to 74.6%. Screening volumes declined by 1.7% during COVID but rose by 24.3% post-pandemic, with yields <0.003%. Treatment visits declined during COVID and partially recovered, with Amajuba exceeding pre-COVID engagement. Glycaemic control improved post-pandemic (p = 0.041; p = 0.00098). Amputation rates declined overall, though some districts remained high.Conclusion: COVID-19 disrupted diabetes care in KZN, contributing to underdiagnosis and service reductions, with a sharp post-pandemic rise in cases. Strengthening chronic care systems is essential for resilience during health crises.