Adoption of Telemedicine for Type 1 Diabetes Care During the COVID-19 Pandemic

Abstract

Background: We describe the utilization of telemedicine visits (video or telephone) across the T1D Exchange Quality Improvement Collaborative (T1DX-QI) during the COVID-19 pandemic. Metrics, site-level survey results, and examples of interventions conducted to support telemedicine in type 1 diabetes (T1D) are shown. Methods: Thirteen clinics (11 pediatric, 2 adult) provided monthly telemedicine metrics between December 2019-August 2020 and 21 clinics completed a survey about their telemedicine practices. Results:The proportion of telemedicine visits in T1DX-QI before the pandemic was less than 1%, rising to an average of 95.2% in April 2020 (range 52.3% to 99.5). Three sites initially used mostly telephone visits before converting to video visits. By August 2020, the proportion of telemedicine visits decreased to an average of 45% across T1DX-QI (range 10% to 86.6%).The majority of clinics (62%) performed both video and telephone visits; Zoom was the most popular video platform used. Over 95% of clinics reported using CareLink™, Clarity®, Glooko™ and/or t:connect® to view device data, with only one center reporting automated data upload into the electronic medical record. The majority of centers had multidisciplinary teams participating in the video visits. All sites reported reimbursement for video visits, and 95% of sites reported coverage for telephone visits early on in the pandemic. Conclusions:There was rapid adoption of telemedicine in T1DX-QI during the COVID-19 pandemic. Future insurance reimbursement for telemedicine visits and the ideal ratio of telemedicine to in-person visits in T1D care remain to be determined.

Patients’ preferences for telemedicine versus in-clinic consultation in primary care during the COVID-19 pandemic

“…Furthermore, at-risk patients, such as those suffering from diabetes or hypertension, prefer to reduce contact with their physician as well as with other patients (for example, regarding queuing time before the consultation). Therefore, during the pandemic, these patients preferred and made more use of telemedicine services [ 10 ].…”

Challenges and Opportunities in Using Telehealth for Diabetes Care

“…This finding raises an important point about how the mix of care modalities offered by specific providers and medical centers during the pandemic has strongly influenced both telehealth use and the overall receipt of care for people with diabetes. Data from clinics participating in the T1DX-QI confirm a wide variety in telehealth use at these centers, both at the start of the pandemic in April 2020 (ranging from 52.3 to 99.5% of visits) and 4 months later in August 2020 (ranging from 10 to 86.6% of visits) (13). Among 777 U.S. survey respondents who reported not using telehealth for their type 1 diabetes care as of autumn 2020, 49% cited their primary reason for not using telehealth was that their providers had not offered video appointments (45).…”

“…With the advent of Health Insurance Portability and Accountability Act (HIPAA)-compliant videoconferencing platforms (12,13) and the introduction of telehealth reimbursement codes (14) over the past two decades, greater use of telehealth became possible in the United States for multiple health conditions. Additionally, several developments within the diabetes world during this time period have enabled health care providers to more easily access and use PGHD for telehealth-based diabetes care.…”

“…Internet-based surveys conducted in spring of 2020 indicated that the majority of U.S. endocrinologists had moved to entirely or predominantly virtual care (43) and that 28% of individuals with type 1 diabetes globally had already engaged in remote diabetes care as a result of the pandemic (44). A recently published study of U.S. clinics participating in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) revealed that telehealth made up only 1% of diabetes visits at these locations before the pandemic but constituted the majority of visits from April through July 2020 (13). From the patient standpoint, an internet survey conducted in autumn of 2020 demonstrated that 65% of U.S. individuals with type 1 diabetes participating in the T1D Exchange patient registry or online community reported using telehealth for their diabetes management during the pandemic (45).…”

“…Nearly all of these factors have varied among diabetes centers during the pandemic, although perhaps the most universal experience has been the challenge in obtaining glycemic data remotely. This challenge is manifested by the fact that 80% of diabetes visits at T1DX-QI clinics in April 2020 lacked A1C data, and by August 2020, after 4-5 months of ongoing telehealth use, this proportion was still as high as 30% (13). The availability of PGHD from diabetes devices at the time of telehealth encounters is harder to evaluate because of inconsistent incorporation of these data in the electronic health record (EHR).…”