The Rapid Transition to Telemedicine and Its Effect on Access to Care for Patients With Type 1 Diabetes During the COVID-19 Pandemic

Abstract

We compared the uptake of telemedicine for diabetes care across multiple demographic groups during the coronavirus disease 2019 pandemic to understand the impact of telemedicine adoption on access to care. RESEARCH DESIGN AND METHODSThe study analyzed demographic information of patients with type 1 diabetes seen between 1 January 2018 and 30 June 2020 at a single center. We compared the odds of completing a visit via telemedicine across multiple demographic characteristics. RESULTSAmong 28,977 patient visits, the odds of completing a visit via telemedicine were lower among non-English-speaking (1.7% vs. 2.7%; adjusted odds ratio [aOR] 0.45, 95% CI 0.26-0.79) and Medicaid-insured (32.0% vs. 35.9%; aOR 0.83, 95% CI 0.72-0.95) pediatric patients. No clinically significant differences were observed for other demographic factors. CONCLUSIONSRapid transition to telemedicine did not significantly impact access to diabetes care for most demographic groups. However, disparities in access to care for historically marginalized groups merit close attention to ensure that use of telemedicine does not exacerbate these inequities.Delivering high-quality diabetes care within the constraints of our current medical system is challenging, particularly for low socioeconomic status, non-English-speaking, and rural populations (1,2). Providers and commentators have expressed concern that the rapid shift to telemedicine as a result of the coronavirus disease 2019 (COVID-19) pandemic might have unintended negative consequences (3-5). We analyzed demographic data from patients with type 1 diabetes from the pediatric and adult diabetes clinics of a major academic diabetes center to identify demographic differences associated with this shift in care delivery and the potential impact on patients' access to diabetes care.

Age and Racial Disparities in Telehealth Use Among People with HIV During the COVID-19 Pandemic

“…Both initiation of telehealth and rapid increases in telehealth appointments due to the COVID-19 pandemic have been seen, but disparities exist in patient utilization of telehealth [2,[4][5][6][7]. Several studies have found that older patients, non-English speaking patients, and patients with public insurance were less likely to use telehealth as compared to in-person visits [4,5,[7][8][9].…”

The experience of patients with diabetes with the use of telemedicine and teleassistance services during the COVID-19 pandemic in Italy: Factors associated with perceived quality and willingness to continue

“…A recent publication of Tilden et al evaluated the effect of such a rapid shift to telemedicine and its impact on access to care in patients with type 1 diabetes. Although some of the patients had the opportunity to continue to receive health care even remotely, some categories had fewer opportunities to benefit from this kind of care, especially patients with lower education, non-English speaking communities and paediatric patients [31]. According to our results and to the available literature, great caution should be exercised to avoid introducing elements of iniquity in the access to care, thus creating a new form of fragility and marginality in the population.…”

Video Consultation Versus In-Person Clinic Visit for Glycemic Control in Type 2 Diabetes during COVID-19 Pandemic (VIP-CD Study)

“…Not only has it helped us to stay connected and impart medical care to the patient, it has also delivered reassurance and the message of vaccination to the patient. Previous studies have shown the efficacy of telemedicine in improving glycemic control,[ 4 8 10 11 12 ] weight reduction,[ 7 ] dyslipidemia,[ 5 ] diabetic foot care,[ 14 ] and patient satisfaction. [ 6 13 ]…”

“…Many studies and meta-analyses have unequivocally established telemedicine as a suitable alternative to manage noncritical diabetes. [ 3 4 5 6 7 8 9 10 11 ] Some studies have been performed during COVID-19 pandemic,[ 10 12 13 ] and their results pertaining to patient care, satisfaction, and adverse events are encouraging. Telemedicine-driven studies concerning diabetes have been conducted in India during the COVID-19 pandemic.…”