(CSEMP077) HOW HAS VIRTUAL CARE DELIVERY CHANGED THE PATTERNS OF CARE IN DIABETES MANAGEMENT PRE AND DURING THE COVID-19 PANDEMIC?

Abstract: How has virtual care delivery changed the patterns of care in diabetes management pre and during the COVID-19 pandemic?


Background: The COVID-19 pandemic accelerated the use of virtual care for management of many health care conditions including diabetes.


Objective: This study aimed to compare how patterns of care for diabetes have changed as a result of virtual care and the COVID-19 pandemic at a large academic ambulatory care facility.


Methods: Patients were included who had an initial diabetes visit in the endocrinology practice between September 15, 2019 and September 14, 2020. Chi-square test and Fisher's exact test were used to determine differences in care patterns between visits pre (September 15, 2019 – March 14, 2020) and during COVID-19 (March 15, 2020 – September 14, 2020).


Results: This study included 120 patients with an initial visit for diabetes pre COVID-19 (mean age 54.2; mean A1C 8.7%; 56% women) and 155 patients with an initial diabetes visit during COVID-19 (mean age 48.7; mean A1C 9.1%; 60% women). Majority of initial visits during the pandemic were completed by phone (83.2% vs. 7.1% in person vs. 9.7% video). There were more no-shows pre COVID-19 (17.5% vs. 12.3%; p=0.0351); however there were more patients lost to follow-up (28.4% vs. 23.3%; p=0.0155) during COVID-19. In a 1 year period, patients had more follow-up visits during COVID-19 compared to pre COVID-19 (2.93 vs. 2.14; p=0.00006).

During COVID-19, 54.2% of patients had no weight measured or reported at initial visits compared to 4.2% pre COVID-19 (p < 0.0001). Similarly, the proportion of patients that had no blood pressure measured/reported at initial visits during COVID-19 was 86.5% compared to 2.5% pre COVID-19 (p < 0.0001). In terms of blood-work ordered, there was no difference for most labs except urine microalbumin: creatinine ratio which was ordered less during COVID-19 (63.4% vs. 73.3%; p=0.0122). There were more changes made to insulin doses at follow-up visits pre COVID-19 (66.7%) compared to during COVID-19 (47.4%; p=0.0245). However, at initial visits pre COVID-19, there were less changes made to oral anti-hyperglycemic doses (23.4%) compared to during COVID-19 (50%; p=0.00079), and more changes made to anti-hypertensive doses (7.1%) compared to during COVID-19 (0%; p=0.0152). There was no difference in the amount of new insulin starts pre and during COVID-19 (7.8% vs 5.9%; p=0.739).


Conclusion: This study helps us understand how patterns of care for diabetes have changed as a result of virtual care and the COVID-19 pandemic.