Has the Pandemic Changed Type 1 Diabetes Care for Good?
When the COVID-19 pandemic began, many doctors started providing care via telemedicine. Now, a new survey of people with type 1 diabetes suggests many like remote care and hope it continues in the future.
Among the survey respondents who had a telemedicine visit during the pandemic, 86% found the remote appointments useful, and 75% said they planned on having remote appointments in the future, according to the Swiss study.
"COVID really forced the issue of access to telemedicine. There were a lot of restrictions that made it difficult to access telemedicine in the past that were lifted with COVID. But will they remain available?" said Dr. Mary Pat Gallagher, director of the Pediatric Diabetes Center at NYU Langone Health in New York City.
"It's quite clear from my clinical experience that people really like this and would prefer it. I would like this to continue to be an option for our families," added Gallagher, who was not involved in the current research.
People with type 1 diabetes need to take multiple daily insulin shots or receive insulin via an insulin pump because they don't make enough insulin on their own. Insulin is a hormone that ushers sugar from foods into the body's cells for fuel.
Replacing the body's natural insulin is a balancing act, and insulin doses often need to be adjusted throughout a person's life. People with type 1 diabetes typically see their diabetes doctor about four times a year.
Type 1 diabetes care may be particularly well-suited to telemedicine, according to the study authors. Many visits are based around a review of blood sugar data and whether or not any adjustments are needed to daily insulin therapy. And the devices used by people with diabetes can provide a wealth of data over an internet connection.
"Virtual visits also avoid the costs, time and inconveniences of travel, which can be especially useful for people who live far from their health care providers or who have mobility issues that make in-person appointments difficult," study author Sam Scott, of the University of Bern, and colleagues wrote in the report.
The new research included responses from nearly 7,500 people with type 1 diabetes from 89 countries. Survey responses were collected from March 24 through May 5, 2020.
During that time, 28% of those who answered the survey said they had had a telemedicine visit (72% had a telephone visit and 28% had a video call).
The majority of those who tried telemedicine said it was useful. Age and education levels didn't appear to affect whether or not someone liked telehealth.
One factor that did seem to make a difference was poor blood sugar management, especially in men. Forty-five percent of men with an A1C above 9% said their telemedicine visits weren't useful.
In addition, 20% of women with A1Cs above 9% said telemedicine visits weren't useful. A1C is a blood test that estimates blood sugar management over two to three months. Generally, adults with type 1 diabetes aim for a level of 7% or less.
Gallagher said some groups could have a hard time adjusting to telemedicine, such as those who don't have reliable internet connections. Telemedicine visits are also harder if people don't use diabetes devices, such as continuous glucose monitors, that provide vital information that's extremely helpful for a telemedicine visit.
Sanjoy Dutta, vice president of research for JDRF (formerly the Juvenile Diabetes Research Foundation), said there are challenges to telemedicine, such as protecting the information from virtual visits (cybersecurity).
But there are clear benefits, too. "Very few clinics have comprehensive type 1 diabetes care. If you need to have a consultation with an eye doctor or kidney specialist, it means another day of travel and taking time from work. With advances in telemedicine, you have the potential to provide comprehensive care on the same call. Telemedicine is making a more pliable, flexible system," Dutta explained.
He also noted that telemedicine could be helpful for people who have a hard time missing work.
Neither expert thought that telemedicine could completely replace in-person care. But they said it could be a helpful and convenient addition to usual care.
"I think the future for telemedicine is very bright, and the pandemic has accelerated the way we're using it. I think it will improve outcomes and access to care," Dutta said.
The findings were presented recently at the virtual meeting of the European Association for the Study of Diabetes, and published recently in the journal Endocrinology, Diabetes and Metabolism.
Read more about care for type 1 diabetes from the U.S. Centers for Disease Control and Prevention.
SOURCES: Mary Pat Gallagher, MD, director, Pediatric Diabetes Center, Hassenfeld Children's Hospital, NYU Langone Health, New York City; Sanjoy Dutta, PhD, vice president, research, JDRF; Endocrinology, Diabetes and Metabolism, Aug. 29, 2020
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