Pandemic Upped Telemedicine Use 100-Fold in Type 2 Diabetes

Mitchel L. Zoler, PhD

July 07, 2021

The COVID-19 pandemic jump-started a significant role for telemedicine in the routine follow-up of US patients with type 2 diabetes, based on insurance-claims records for more than 2.7 million American adults during 2019 and 2020.

During 2019, 0.3% of 1,357,029 adults with type 2 diabetes in a US claims database, OptumLabs Data Warehouse, had one or more telemedicine visits. During 2020, this jumped to 29% of a similar group of US adults once the pandemic kicked in, a nearly 100-fold increase, Sadiq Y. Patel, PhD, and coauthors write in a research letter published online July 6 in JAMA Internal Medicine.

The data show that telemedicine visits didn't seem to negatively impact care, with A1c levels and medication fills remaining constant across the year.

But Robert A. Gabbay, MD, PhD, chief science & medical officer for the American Diabetes Association, said these results, while reassuring, seem "quite surprising" relative to anecdotal reports from colleagues around the United States.

It's possible they may only apply to the specific patients included in this study — which was limited to those with either commercial or Medicare Advantage health insurance — he noted in an interview.

Diabetes Well-Suited to Telemedicine

Patel, of the Department of Health Care Policy at Harvard Medical School in Boston, Massachusetts, and coauthors say the information from their study showed "no evidence of a negative association with medication fills or glycemic control" among these patients during the pandemic in 2020 compared with the pre-pandemic year 2019.

During the first 48 weeks in 2020, A1c levels averaged 7.16% among patients with type 2 diabetes compared with an average of 7.14% for patients with type 2 diabetes during the first 48 weeks of 2019. Fill rates for prescription medications were 64% during 2020 and 62% during 2019.

A1c levels and medication fill rates "are important markers of the quality of diabetes care, but obviously not the only important things," said Ateev Mehrotra, MD, corresponding author for the study and a researcher in the same department as Patel.

"Limited to the metrics we looked at and in this population we did not see any substantial negative impact of the pandemic on the care for patients with type 2 diabetes," Mehrotra said in an interview.

"The pandemic catalyzed a tremendous shift to telemedicine among patients with diabetes. Because it is a chronic illness that requires frequent check-ins, diabetes is particularly well suited to using telemedicine," he added.

Telemedicine Not a Complete Replacement for In-Patient Visits

Gabbay agrees that "Providers and patients have found telemedicine to be a helpful tool for managing patients with diabetes."

But "Most people do not think of this as a complete replacement for in-person visits, and most [US] institutions have started to have more in-person visits. It's probably about 50/50 at this point," he said in an interview.

"It represents an impressive effort by the healthcare community to pivot toward telehealth to ensure that patients with diabetes continue to get care."

Nevertheless, Gabbay added that "despite the success of telemedicine many patients still prefer to see their providers in person. I have a number of patients who were overjoyed to come in and be seen in person even when I offered telemedicine as an alternative. There is a relationship and trust piece that is more profound in person."

And he cautioned that although A1c "is a helpful measure, it may not fully demonstrate the percentage of patients at high risk."

The data in the study by Patel and coauthors showing a steady level of medication refills during the pandemic "is encouraging," he said, speculating that "people may have had more time [during the pandemic] to focus on medication adherence."

More Evidence of Telemedicine's Leap

Other US sites that follow patients with type 2 diabetes have recently reported similar findings, albeit on a much more localized level.

At Vanderbilt University Medical Center in Nashville, telemedicine consultations for patients with diabetes or other endocrinology disorders spurted from essentially none prior to March 2020 to a peak of nearly 700 visits/week in early May 2020, and then maintained a rate of roughly 500 telemedicine consultations weekly through the end of 2020, said Michelle L. Griffth, MD, during a talk at the recent virtual American Diabetes Association (ADA) 81st Scientific Sessions.

"We've made telehealth a permanent part of our practice," said Griffith, medical director of Telehealth Ambulatory Services at Vanderbilt. "We can use this boom in telehealth as a catalyst for diabetes-practice evolution," she suggested.

It was a similar story at Scripps Health in Southern California. During March and April 2020, video telemedicine consultations jumped from a prior rate of about 60/month to about 13,000/week, and then settled back to a monthly rate of about 25,000-30,000 during the balance of 2020, said Athena Philis-Tsimikas, MD, an endocrinologist and vice president of the Scripps Whittier Diabetes Institute in La Jolla, California. (These numbers include all telehealth consultations for patients at Scripps, not just patients with diabetes.)

"COVID sped up the process of integrating digital technology into healthcare," concluded Philis-Tsimikas. A big factor driving this transition was the decision of many insurers to reimburse for telemedicine visits, something not done pre-pandemic, she added.

The study received no commercial support. Patel, Mehrotra, Griffith, Philis-Tsimikas, and Gabbay have reported no relevant financial relationships.

JAMA Intern Med. Published online July 6, 2021. Full text

Mitchel L. Zoler is a reporter for Medscape and MDedge based in the Philadelphia area. @mitchelzoler

For more diabetes and endocrinology news, follow us on Twitter and Facebook.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.