Outpatient Diabetic Outcome During the Covid-19 Pandemic: A Retrospective Single Center Analysis

Background: Previous studies have shown that telemedicine is an effective alternative method for health care delivery. The COVID-19 pandemic has acutely stimulated expansion of telemedicine across the country. This study aimed to determine characteristics of telehealth visit and short term HbA1c outcome in patients with diabetes mellitus in endocrinology clinic during the COVID-19 pandemic. Methods: A single center retrospective chart review was conducted in all patients seen in endocrinology clinic for diabetes mellitus between 5/27/2020–7/20/2020. Data were extracted from electronic medical record. The primary research question is percentage of patients who achieved HbA1C ≤ 8% at 3 month follow up. Secondary research questions are characteristic of patients and clinic visits, diabetic technology usage, 3 month follow up mean HbA1c and HbA1c change. This project was approved by the institutional review boards. Results: Two hundred and six diabetic patients were seen: 72 (35%) in person, 49 (24%) phone visit, and 85 (41%) VDO visit. Mean age for patients adopted in person visit was 57 (SD 15) years, phone visit was 68 (SD 13) years and VDO visit was 54 (SD 18) years, p <0.001. Male percentage for in person, phone and VDO visit was 44%, 59% and 61% respectively, p 0.09. New consult visit percentage for in person, phone and VDO visit was 7%, 2% and 5% respectively, p 0.46. Percentage of patients using insulin pump or continuous glucose monitoring for in person, phone and VDO visit was 33%, 43% and 54%, respectively, p 0.03. Baseline HbA1c was done in 89% (64/72) in person, 45% (22/49) phone and 52% (44/85) VDO visit. Among patients who had baseline HbA1c, average HbA1c was 8.6% (SD 1.8) for in person visit, 8.0% (SD 1.1) for phone visit and 8.1% (SD 1.8) for VDO visit, p 0.25. At 3 months, HbA1c was done in 38% of patients who had in person visit, 36% phone visit, and 43% VDO visit. Among patients who had 3 month follow up HbA1c, HbA1c ≤ 8% was achieved in 50%, 61% and 69% for in person, phone and VDO respectively, p 0.56. Mean 3 month follow up HbA1c was 8.1% (SD 1.3), 7.7% (SD 0.9) and 7.8% (SD 1.6) for in-person, phone and VDO visit respectively, p 0.47. Comparing mean HbA1c in patients who had both baseline and 3 month follow up HbA1c, changes were significant for in person visit 9.1% to 8.1% (p 0.01) and VDO visit 8.7% to 7.6% (p 0.01). No significant change in 3 month follow up HbA1c was observed in phone visit, 7.7% to 7.6% (p 0.88). Conclusions: This retrospective study showed that during the COVID-19 pandemic, no differences in short term HbA1c outcome (3 month follow up mean HbA1c and percentage of patients who achieved HbA1c ≤ 8%) were observed among patients who adopted in-person and telehealth visit. Patients who adopted phone visit appeared to be older; and there was more diabetic technology usage (insulin pump or continuous glucose monitoring) among patients who adopted telehealth (phone and VDO) compared to in person visit.