Substitution of telemedicine for clinic visit during the COVID‐19 pandemic of 2020: Comparison of telemedicine and clinic visit

Abstract

Aims/Introduction The purpose of this retrospective observational cohort study was to compare outpatient diabetes care and glycated hemoglobin (HbA1c) level during the coronavirus disease 2019 pandemic in 2020 with 2019, and to compare the glucose‐lowering effect of telemedicine and clinic visits during the state of emergency in Japan declared from 7 April to 25 May (inter‐period) 2020. Materials and Methods A total of 13 weeks before and after the inter‐period were designated as the pre‐period and post‐period, respectively. The number of study participants who had clinic visits during the pre‐period and the post‐period were 3,333 in 2020 and 3,608 in 2019. Propensity score matching was carried out to compare the effect of telemedicine and clinic visits on diabetes control in 2020 among diabetes patients with insufficient glucose control (HbA1c ≥7%). The primary outcome was post‐period HbA1c. Results The major difference between 2020 and 2019 was the use of telemedicine in 2020. After adjustment for age, sex, diabetes type, pre‐period HbA1c and pre‐period body mass index, glycemic control evaluated by HbA1c was significantly worse in the post‐period of 2020 than 2019. In the propensity score‐matched 618 pairs, the clinic visit group had significantly better post‐period HbA1c than the telemedicine group (7.5% vs 7.4%, P = 0.023). Conclusions Glycemic control was slightly, but significantly, worse in 2020 than 2019. Although telemedicine significantly improved glycemic control during the coronavirus disease 2019 pandemic in 2020, clinic visits improved HbA1c significantly more. The substitution of telemedicine for clinic visits appears to be a viable option under emergency conditions, but clinic visits might be a better option when possible.

Association of self‐stigma with glycated hemoglobin: A single‐center, cross‐sectional study of adults with type 1 diabetes in Japan

“…Fourth, we were unable to assess experienced or perceived stigma in the present study, for there are no scales in publish that assess experienced or perceived stigma in Japanese at present. Fifth, we conducted the study during the COVID‐19 pandemic, and the spread of COVID‐19 might have had an impact on glycemic values 40–42 . In addition, the present study did not include assessments of total daily insulin dose and experiences of diabetes education with a certified diabetes educator, which might relate to self‐stigma or glycemic outcome.…”

Current situation of telemedicine research for cardiovascular risk in Japan

“… Both office visit (OR, 1.53) and telemedicine (OR, 1.56) were independently associated with the HbA1c levels of < 7.0%. Onishi et al, 2022 [ 38 ] Diabetes Retrospective study Pre-period of COVID-19, 2019 years ( n = 3608) Post-period of COVID-19, 2020 years ( n = 3333) 68.5 years 68.7 years - Same as above. In year 2020, office visit group had a significantly better post-HbA1c levels than telemedicine group.…”

“…Onishi et al retrospectively evaluated the efficacy of telemedicine and clinic visit on glycated hemoglobin (HbA1c) levels during the state of emergency in response to the outbreak of COVID-19 [ 38 , 39 ]. Telemedicine consisted of telephone consultation and its application was determined by the doctors based on patients’ health status, living areas, and other conditions.…”

“…In a multiple regression analysis that involved 2727 diabetic patients, both telemedicine visits and office visits were independently associated with the improved HbA1c levels (<7%) evaluated 8 weeks after the state of emergency [ 39 ]. However, in the propensity score analysis that involved 618 pairs with pre-HbA1c levels of 7% or higher, the clinic visit group had a significantly better post-HbA1c levels than the telemedicine group (7.4% vs. 7.5%; P = 0.02) [ 38 ].…”

“…In addition, given that the current medical evidence is mostly based on the basis of in-person medical counseling in a usual state, there is also a need to develop a sort of guidelines for the implementation of telemedicine to control and improve the quality. For example, one study found that HbA1c levels in diabetic patients were rather worse in the telemonitoring group [ 38 ]; in that study, the application of telemedicine depended on each physician’s decision.…”