COVID-19 and Health System Response for Management of Diabetes in Bangladesh: A national qualitative study of patients with diabetes and key healthcare professionals/policy makers

Background: Uncontrolled diabetes can lead to exacerbation of symptoms and life-threatening complications. Consequently, there is a need to explore patient experience regarding the prevention and treatment of diabetic patients amidst the restrictions and lockdown measures in response to COVID-19. The objective of this study was to assess the response of the healthcare system for preventive care and treatment of people with diabetes in Bangladesh during COVID-19, and to analyze the health-seeking behavior of diabetes patients amidst social distancing and lockdown measures Method: A descriptive qualitative design was used to collect data regarding the ability of people living with diabetes to access medication, laboratory services, and preventative care during the pandemic. The data collection process involved 12 focus group discussions (FGDs) with people living with diabetes, and 30 key informant interviews (KIIs) with senior diabetologist, health service managers, leaders of different diabetes-related associations, and policymakers from the local to the national level. The discussion issues were structured around the WHO framework that describes health systems in terms of six building blocks. In addition, different treatment guidelines, scientific articles, relevant reports, and 20 well-circulated newspapers were analyzed concerning the treatment of diabetic patients. Results: 44% of the respondents were aged 55-60 years, with an informed noticeable disruption of essential diabetes care services, intensified by high COVID-19 infection rates. Besides, 78% of the service receiver participants reported not seeing any government-issued public announcements regarding diabetes management on television or newspapers. There are also concerns with the current heath sector. Conclusions: The study findings highlighted major concerns surrounding the healthcare response to deliver care for patients with diabetes during the pandemic, driven mainly by restricted access to treatment under lockdown measures coupled with a reluctance from health care providers to see patients due to high COVID-19 infection rates arising from concerns with a lack of personal protective equipment. Necessary measures can gradually bring some change in the healthcare system promote healthy lifestyles and adherence to prescribed medicines together with raising awareness about the potential risk factors of diabetes.