Visual Abstract

Over the pandemic, little is known on the extent to which in-person visits (IP) have been reduced and replaced with telehealth in patients with type 1 diabetes (T1D). In this study, we reviewed aging T1D patients (65 years and older) seen in IP, phone visits (PV), and video visits (VV) at Joslin Diabetes Center from March to September in 2020, 2019, and 2018. Over the 7-month period, 3,276 clinical visits were attended in 2018, 2,980 in 2019, and 2,565 in 2020. The number of IP visits decreased by 88.89% in 2020. Over the same periods, PV and VV increased from 4 and 0 respectively in 2018 to 1,338 and 602 each in 2020 (>1000%). The number of VV increased from 78 in March-April 2020 to 524 in July-Sept 2020 (572%). In contrast, PV dropped by 52% (907 to 431) over the same period. There were no differences by gender in PV (chi=0.01, P=0.96) and VV (chi=2.45, P=0.12) in 2020. Decreased IP visits and increased in PV and VV were observed in 100% of clinical services (Figure 1). The largest changes were seen in Mental Health services; IP visits from 141 to 2 (>1000% decrease) and VV increases from 28 to 126 (350%). In this EHR review of T1D aging adults, we saw a drastic decline in IP visits during the pandemic. This was only partly offset by increases in telehealth services. Further research is needed to understand how decreased access to IP care and increased use of telehealth services may impact long term DM management.


A. Adam: None. E. Toschi: Consultant; Self; Medtronic. M. Munshi: Consultant; Self; Sanofi. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at