LAUSR

Background: Routine health screening and monitoring declined when COVID-19 was declared a global pandemic on March 11, 2020. Early reports found Hemoglobin A1c (HbA1c) testing declined nearly 50% among patients with diabetes from March to May in 2020 compared with 2019. At-home sample collection aligns with social distancing practices and mitigates potential exposure to SARS-CoV-2 in public settings, including clinics. This study sought to characterize utilization of at-home lab tests and resulting HbA1c and lipid profiles in pre-pandemic and pandemic cohorts. Methods: Results from individuals who used at-home collection to measure HbA1c, total cholesterol, calculated LDL-C, HDL, triglycerides, and hs-CRP between October 2017 and December 2020 were identified from a commercial consumer database. A total of 19,076 test-takers were included, of which 12,587 had HbA1c measurements and 13,624 had lipid measurements. Results: Use of tests measuring HbA1c increased 60.3% in February-May 2020, around the time of pandemic declaration, and to a lesser degree from June-December when compared with 2019 use. Use of tests measuring lipids increased 61.9% during the same time periods. The mean HbA1c (%) in the pre-pandemic vs. pandemic cohort was 5.47 ± 0.72 (N = 3476) vs. 5.69 ± 0.87 (N = 2851) among users ages 18-44, 5.85 ± 1.04 (N = 2740) vs. 6.12 ± 1.17 (N = 1709) among users ages 45-64, and 6.05 ± 0.91 (N = 703) vs. 6.47 ± 1.34 (N = 513) among users ages 65+. Overall, the percent of individuals with an HbA1c characteristic of prediabetes and diabetes (HbA1c ≥ 5.7% and ≥ 6.5%, respectively) was 23.4% and 7.0% in 2018 (N = 2342), 26.6% and 8.5% in 2019 (N = 3751), and 38.8% and 14.7% of total users in 2020 (N = 6173). Conclusions: The impact of the COVID-19 pandemic on at-home lab testing demonstrates the feasibility and increased usage of at-home sample collection for routine health monitoring particularly among people with elevated HbA1c.