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Telemedicine For Management of Diabetes Amid COVID-19 Concerns: Does It Work?

Nov 17, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Melinda Rodriguez, PharmD Candidate 2021, Lake Erie College of Osteopathic Medicine – L|E|C|O|M School of Pharmacy

Patients are relieved to know that care continues via telemedicine through the COVID-19 (coronavirus) pandemic. 

The COVID-19 pandemic has changed the world in many ways. As hospitals and clinics shift their operations to remote modalities, telemedicine has become the forefront of healthcare. Although telemedicine has some limitations, this relatively new avenue of healthcare has increased access to medical care during the lockdown, allowing for social distancing and mitigating personal protective equipment shortages. Telephone and video consultations are among the limited healthcare access modes available for those needing chronic disease state management. A new study from Slovenia, published in Diabetes Research and Clinical Practice, aims to discover the level of satisfaction of diabetes management in people with type 1 (T1DM) and type 2 diabetes (T2DM) during the coronavirus lockdown.  

 

Researchers Karin Kanc, Jana Komel, and Miha Kos piloted a home HbA1c testing and telemedicine program in Slovenia during April and May of 2020. Patients were selected from diabetes centers in Ljubljana and Koper. The center in Ljubljana managed diabetes for roughly 2000 patients, and the center in Koper managed diabetes for approximately 8000 patients.  Patients with T1DM or T2DM, aged 18 and up, who performed self-monitoring of blood glucose (SMBG) and had upcoming appointments were identified. Staff invited these patients to attend telephone consultations. Consent forms were mailed to 100 participants meeting criteria. The HbA1c testing kit, Bio-Rad D-10™, was also sent along with pictorial instructions, a survey regarding the telemedicine experience, and a return envelope with pre-paid postage for samples.  

The survey contained statements regarding the patients level of satisfaction toward the home HbA1C test and telemedicine appointment. Patients were to answer yes or no next to each statement to indicate whether they agreed or disagreed. Convenience, clarity of instructions, difficulty level, degree of pain, perceptions of result accuracy, and general feelings regarding the telemedicine appointment were topics of interest. The document also provided an additional section for qualitative comments. 

A total of 98 patients completed the survey. The majority of patients were married, representing 68% of the participants. Sixty percent were women. Participants’ mean age was 52 years, mean diabetes duration was 15 years (SD 9.7), and mean HbA1c was 7.5%. Ninety-eight percent of patients preferred telephone consultations, 6% preferred WhatsApp, and 2% preferred Skype. The patient characteristics were mostly different between the Ljubljana and Koper groups, with more T1DM patients (46% vs. 26%) and insulin users (54% vs. 32%) in Ljubljana compared to Koper. The mean HbA1c for patients in Ljubljana (8.2%) was also higher than that of patients in Koper (7.0%).  

According to the survey results, all 98 patients found the instructions clear and the materials easy and convenient to use. None of the patients reported any issues receiving the kit. The kits were simple to use, and samples were easily obtained and sent to the lab. Ten percent of patients, however, reported pain during fingerprick. Only two patients reported communication barriers with their physicians, and one expressed a preference for in-person visits. All patients expressed appreciation toward their providers for the extra effort dedicated during the coronavirus pandemic. The patients described feeling comforted, knowing that medical care was available remotely during COVID-19. When asked if the patient would consider resuming telemedicine appointments after COVID-19 is over, 72% responded positively. Twenty-five patients provided additional comments. Most comments were positive and pertained to the convenience for time and travel, simplicity of methods, and clarity of instructions. A few patients expressed a preference for hybrid in-person and remote appointments. Though rare, a few negative comments pertained to the amount of blood required for the test and lack of fasting instructions. 

Uploadable data from continuous glucose monitors and insulin pumps allow for a smooth transition from in-person visits to telemedicine during the COVID-19 pandemic. The majority of people living with diabetes find these remote consultations relatively stress free and convenient. Although this technology may not be suitable for all patients, particularly those living in remote areas where access to telephone and internet may not be available, telemedicine is becoming more frequently used worldwide. Increased access to care continues to be a problem for many. However, as these technologies continue to expand globally, there is reason for optimism about its impact on millions of people living with diabetes and its benefits during infectious outbreaks, such as the one we are currently experiencing. 

Practice Pearls: 

  • Patients report high levels of satisfaction with remote diabetes management via telemedicine. 
  • Patients feel comforted and less lonely, knowing that providers were still available for telephone or web-based consultations.  
  • Telemedicine is easy and convenient for the majority of patients with diabetes. 

 

Kanc, J.Komel, M. Kos, J. Wagner, H(ome)bA1c Testing and Telemedicine: High Satisfaction of People with Diabetes for Diabetes Management During COVID-19 Lockdown, Diabetes Research and Clinical Practice  

 

Melinda Rodriguez, PharmD Candidate 2021, Lake Erie College of Osteopathic Medicine – L|E|C|O|M School of Pharmacy