Challenges and Opportunities in Using Telehealth for Diabetes Care

Crossen, Stephanie S.; Bruggeman, Brittany; Haller, Michael J.; Raymond, Jennifer

doi:10.2337/dsi21-0018

Cited by 30 publications

(19 citation statements)

References 53 publications

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“…Findings from this study are in line with recent literature demonstrating the acceptability and benefits of telehealth-based delivery of diabetes care, which is increasingly becoming a recommended avenue to increase access to care, increase frequency of visits while minimizing travel and time burden, and to monitor patients remotely between visits. [19][20][21][22] The SARS-CoV-2 pandemic led to a rapid acceleration of expanding the use of telehealth-based care 23,24 and highlighted its potential as major paradigm shift in diabetes care 25,26 as well as some challenges (e.g., risk of widening disparities and gaps in access particularly with rural populations; concern about less personalized care over time; lower rates of anthropometric and lab measurements). [27][28][29] Recent research has demonstrated that most patients and providers have been satisfied with telehealth-based diabetes care delivery.…”

Section: Discussionmentioning

confidence: 99%

‘Much more convenient, just as effective’: Experiences of starting continuous glucose monitoring remotely following Type 1 diabetes diagnosis

et al. 2022

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Aim Initiating continuous glucose monitoring (CGM) shortly after Type 1 diabetes diagnosis has glycaemic and quality of life benefits for youth with Type 1 diabetes and their families. The SARS‐CoV‐2 pandemic led to a rapid shift to virtual delivery of CGM initiation visits. We aimed to understand parents' experiences receiving virtual care to initiate CGM within 30 days of diagnosis. Methods We held focus groups and interviews using a semi‐structured interview guide with parents of youth who initiated CGM over telehealth within 30 days of diagnosis during the SARS‐CoV‐2 pandemic. Questions aimed to explore experiences of starting CGM virtually. Groups and interviews were audio‐recorded, transcribed and analysed using thematic analysis. Results Participants were 16 English‐speaking parents (age 43 ± 6 years; 63% female) of 15 youth (age 9 ± 4 years; 47% female; 47% non‐Hispanic White, 20% Hispanic, 13% Asian, 7% Black, 13% other). They described multiple benefits of the virtual visit including convenient access to high‐quality care; integrating Type 1 diabetes care into daily life; and being in the comfort of home. A minority experienced challenges with virtual care delivery; most preferred the virtual format. Participants expressed that clinics should offer a choice of virtual or in‐person to families initiating CGM in the future. Conclusion Most parents appreciated receiving CGM initiation education via telehealth and felt it should be an option offered to all families. Further efforts can continue to enhance CGM initiation teaching virtually to address identified barriers.

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Section: Discussionmentioning

confidence: 99%

‘Much more convenient, just as effective’: Experiences of starting continuous glucose monitoring remotely following Type 1 diabetes diagnosis

et al. 2022

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“…While frequent routine care is crucial for improving diabetes control and reducing related complications risks [ 10 , 11 ], there were challenges providing in-person diabetes management care during COVID-19 [ 12 ]. Benefits of routine in-person care include face-to-face patient-provider interactions, optimized setting for lab measurements, and lower technology burden on patients [ 13 ]. However when these barriers exist, telehealth may provide alternative solution to replicate in-person care [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Benefits of routine in-person care include face-to-face patientprovider interactions, optimized setting for lab measurements, and lower technology burden on patients [13]. However when these barriers exist, telehealth may provide alternative solution to replicate in-person care [12,13]. Many published trials and meta-analyses have shown improved glycemic control and increased frequency of care via telehealth visits among patients with diabetes [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes

Adhikari

Titus

Baum

et al. 2023

BMC Health Serv Res

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Background While emerging studies suggest that the COVID-19 pandemic caused disruptions in routine healthcare utilization, the full impact of the pandemic on healthcare utilization among diverse group of patients with type 2 diabetes is unclear. The purpose of this study is to examine trends in healthcare utilization, including in-person and telehealth visits, among U.S. veterans with type 2 diabetes before, during and after the onset of the COVID-19 pandemic, by demographics, pre-pandemic glycemic control, and geographic region. Methods We longitudinally examined healthcare utilization in a large national cohort of veterans with new diabetes diagnoses between January 1, 2008 and December 31, 2018. The analytic sample was 733,006 veterans with recently-diagnosed diabetes, at least 1 encounter with veterans administration between March 2018–2020, and followed through March 2021. Monthly rates of glycohemoglobin (HbA1c) measurements, in-person and telehealth outpatient visits, and prescription fills for diabetes and hypertension medications were compared before and after March 2020 using interrupted time-series design. Log-linear regression model was used for statistical analysis. Secular trends were modeled with penalized cubic splines. Results In the initial 3 months after the pandemic onset, we observed large reductions in monthly rates of HbA1c measurements, from 130 (95%CI,110–140) to 50 (95%CI,30–80) per 1000 veterans, and in-person outpatient visits, from 1830 (95%CI,1640–2040) to 810 (95%CI,710–930) per 1000 veterans. However, monthly rates of telehealth visits doubled between March 2020–2021 from 330 (95%CI,310–350) to 770 (95%CI,720–820) per 1000 veterans. This pattern of increases in telehealth utilization varied by community type, with lowest increase in rural areas, and by race/ethnicity, with highest increase among non-hispanic Black veterans. Combined in-person and telehealth outpatient visits rebounded to pre-pandemic levels after 3 months. Despite notable changes in HbA1c measurements and visits during that initial window, we observed no changes in prescription fills rates. Conclusions Healthcare utilization among veterans with diabetes was substantially disrupted at the onset of the pandemic, but rebounded after 3 months. There was disparity in uptake of telehealth visits by geography and race/ethnicity.

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“…These findings suggest that interruptions in diabetes care in the setting of the COVID-19 pandemic may have affected both the acute care of life-threatening diabetes complications and the management of chronic complications, such as the need for renal replacement therapy. Development and implementation of clinical platforms (e.g., telemedicine) that allow for care continuity in circumstances that prevent regular access to in-person diabetes care should be considered (25).…”

Section: Discussionmentioning

confidence: 99%

Diabetes-related excess mortality in Mexico: a comparative analysis of national death registries between 2017-2019 and 2020

Bello‐Chavolla¹,

Antonio-Villa²,

Fernández‐Chirino³

et al. 2022

Preprint

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OBJECTIVE: Estimate diabetes-related mortality in Mexico in 2020 compared to 2017-2019, following onset of the COVID-19 pandemic. RESEARCH DESIGN AND METHODS: Retrospective, state-level study using national death registries from Mexican adults ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes which listed diabetes as the primary cause of death, excluding certificates with COVID-19 as the primary cause of death. Spatial and negative binomial regression models were used to characterize the geographic distribution and socio-demographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared to average 2017-2019 rates. RESULTS: We identified 148,437 diabetes-related deaths in 2020 (177/100,000 inhabitants), compared with an average of 101,496 deaths in 2017-2019 (125/100,000 inhabitants). In-hospital diabetes-related deaths decreased by 17.8% in 2020 compared to 2017-2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes (130/100,000 inhabitants). Compared with 2018-2019, hyperglycemic hyperosmolar state and diabetic ketoacidosis were the two contributing causes with the highest increase in mortality (128% and 116% increase, respectively). Diabetes-related excess mortality clustered in southern Mexico and was highest in states with higher social lag, higher rates of COVID-19 hospitalization, and higher prevalence of HbA1c ≥7.5%. CONCLUSIONS: Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately out-of-hospital, and were largely attributable to type 2 diabetes and to hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020.

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Challenges and Opportunities in Using Telehealth for Diabetes Care

Cited by 30 publications

References 53 publications

‘Much more convenient, just as effective’: Experiences of starting continuous glucose monitoring remotely following Type 1 diabetes diagnosis

‘Much more convenient, just as effective’: Experiences of starting continuous glucose monitoring remotely following Type 1 diabetes diagnosis

Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes

Diabetes-related excess mortality in Mexico: a comparative analysis of national death registries between 2017-2019 and 2020

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