Access to telehealth and changes in diabetes care patterns during the pandemic: evidence from a large integrated health system in the Southeast USA.

Publication date: Feb 27, 2024

To examine the role of telehealth in diabetes care and management during versus pre-COVID-19 pandemic. We included adults (≥18 years) with prevalent diabetes as of January 1, 2018, and continuously enrolled at Kaiser Permanente Georgia through December 31, 2021 (n=22,854). We defined pre (2018-2019) and during COVID-19 (2020-2021) periods. Logistic generalized estimating equations (GEEs) assessed the within-subject change in adherence to seven annual routine care processes (blood pressure (BP), hemoglobin A1C (HbA1c), cholesterol, creatinine, urine-albumin-creatinine ratio (UACR), eye and foot examinations) pre versus during COVID-19 among telehealth users (ie, more than one telehealth visit per year per period) and non-telehealth users. Linear GEE compared mean laboratory measurements pre versus during COVID-19 by telehealth use. The proportion of telehealth users increased from 38. 7% (2018-2019) to 91. 5% (2020-2021). During (vs pre) the pandemic, adherence to all care processes declined in telehealth (range: 1. 6% for foot examinations to 12. 4% for BP) and non-telehealth users (range: 1. 9% for foot examinations to 40. 7% for BP). In telehealth users, average HbA1c (mean difference: 0. 4% (95% CI 0. 2% to 0. 6%), systolic BP (1. 62 mm Hg (1. 44 to 1. 81)), and creatinine (0. 03 mg/dL (0. 02 to 0. 04)), worsened during (vs pre) COVID-19, while low density lipoprotein (LDL) cholesterol improved (-9. 08 mg/dL (-9. 77 to -8. 39)). For UACR, odds of elevated risk of kidney disease increased by 48% (OR 1. 48 (1. 36-1. 62)). Patterns were similar in non-telehealth users. Telehealth use increased during the pandemic and alleviated some of the observed declines in routine diabetes care and management.

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Concepts Keywords
Adults Diabetes Complications
Diabetes Diabetes Mellitus, Type 2
Hemoglobin Health Services
Laboratory Telemedicine


Type Source Name
disease VO USA
disease MESH COVID-19 pandemic
disease IDO blood
drug DRUGBANK Cholesterol
drug DRUGBANK Creatinine
disease MESH kidney disease
disease MESH Diabetes Complications
disease MESH Diabetes Mellitus Type 2

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