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

Abstract

Objectives: To compare the efficacy of video consultation (VC) for prospective glycemic control against that of in-person clinic visit (IPV) in individuals with type 2 diabetes. Materials and Methods: This is a retrospective, cohort study of 96 individuals with type 2 diabetes followed up for a period of ≤6 months. The cohort was divided into two groups depending on the mode of consultation, namely IPV ( n = 48) and VC ( n = 48). Baseline and follow-up characteristics including glycemic profile and lipid profile were compared. Results: The cohort had a mean age of 55.4 ± 13.8 years, median diabetes duration of 8 (0.3-70) years, a mean body mass index (BMI) of 28.8 ± 5.8 kg/m 2 , 44 (46.3%) females, and uncontrolled hyperglycemia (HbA1c 8.7% ± 1.9%). Both groups were adequately matched at baseline. At the time of first visit, cessation of previous medications was more frequent in the IPV group (37.5% vs 8.3%; P = 0.001) than in the VC group. Follow-up was earlier in the VC group as compared to the IPV group (43.2 vs 87.9 days; P = 0.000). During the follow-up period, both groups had similar and adequate glycemic (mean HbA1c 7% ± 1%) and lipid profile control. Cox regression model showed that the VC group achieved glycemic control quicker as compared to the IPV group. Conclusions: Telemedicine is an effective mode of consultation for attaining glycemic control during COVID-19 pandemic, possibly owing to the quicker follow-up without the risk of potential in-clinic/hospital exposure to COVID-19.

The Effect of Telemedicine in Glycemic Control in Adult Patients with Diabetes during the COVID-19 Era—A Systematic Review

“…The study found a reduction in HbA1c from baseline 8.7% ± 1.8 to 6.9 ± 1.1 in the telemedicine compared to the in-person group, which had a reduction in HbA1c from baseline 8.6% ± 2.1% to 7.0% ± 1.0%, p = 0.88 at six months follow-up. A reduction in FPG (fasting plasma glucose) and PPPG (post prandial plasma glucose) was noted in both groups as well [22].…”

“…These studies showed improvements in TIR, reductions in TAR, improvements in mean glucose values, and reductions in HbA1c% and GMI [18][19][20]. In the retrospective studies following patients with T2D, most studies found that the use of telemedicine led to reductions in HbA1c [21,24], with one study showing it to be equally effective as the standard of care model [22]. Similar findings were observed in studies that used mixed population of patients with T1D and T2D, in which telemedicine led to improvements in HbA1c [25][26][27].…”

“…While some prospective studies showed improvements in TIR, mean glucose value, and reductions in TAR [18][19][20], it is important to note that their small sample size could contribute to their results. Additionally, while reductions in HbA1c were noted across all telemedicine groups [21][22][23][24][25][26][27]30], some studies only found slight improvements [21], and another found no statistical significance among the groups [24]. Furthermore, studies focused on T1D patients used CGM devices to monitor glycemic control [18][19][20], potentially confounding the role of telemedicine.…”

“…In another study, Dutta et al [22] compared glycemic control among a cohort of 96 patients with T2D who were followed for a six-month period through telemedicine or in-person visits [20]. The study found a reduction in HbA1c from baseline 8.7% ± 1.8 to 6.9 ± 1.1 in the telemedicine compared to the in-person group, which had a reduction in HbA1c from baseline 8.6% ± 2.1% to 7.0% ± 1.0%, p = 0.88 at six months follow-up.…”

“…Four studies explored the impact of telemedicine on glycemic control in patients with type 2 diabetes (T2D) [21][22][23][24]. These studies monitored glycemic control through SMBG, fasting, or postprandial blood glucose.…”