855-P: Health Care Delivery for Young Adults (YAs) with Type 1 Diabetes (T1D) during the Pandemic

Background: YAs, aged 18-30 years, with T1D have high risk of worsening glycemic control and loss to follow-up. In March 2020, the COVID-19 pandemic required a sudden change in healthcare delivery from in-person to telehealth visits. We aimed to evaluate use of telehealth by YAs with T1D during this time and assess characteristics associated with telehealth usage.

Method: Frequency of telehealth visits from 3/16/2020 to 9/30/2020 was compared with in-person visits during the same calendar period before COVID-19 (3/16/2019 to 9/30/2020) in a sample of YAs with T1D seen by pediatric and adult diabetes clinicians. The Electronic Health Record provided demographic and clinical data for YAs aged 18-30 with a pre-pandemic A1c. Descriptive statistics and t-tests compared data before and during COVID-19.

Results: Pre-COVID-19, there were 1177 YAs (50% male) with mean±SD age 24.4±3.4 years, T1D duration 12.8±5.9 years, and A1c 8.1±1.6%; 46% were pump-treated, 55% used CGM, and 91% had private insurance. In 2019, there were 2961 visits; in 2020, there were 2701 visits. For the two 6-month periods, the mean number of visits per YA declined significantly, from 2.5±2.5 in 2019 to 2.3±3.1 in 2020 (p=.02). Further, 20% (n=240) of YAs had no visits during the pandemic period. YAs with an A1c <7% pre-pandemic (21%, n=247) had fewer visits during the pandemic than before the pandemic (1.6±2.7 vs. 2.2±2.7, p=.001). YA males (p=.01), those using CGM (p=.02), and those on injection based therapy (p=.0002) had fewer visits during COVID-19.

Conclusions: The majority of YAs (80%) maintained follow-up T1D care during the initial six months of telehealth implementation due to COVID-19, especially those with less favorable characteristics (e.g., A1c ≥7%, no CGM use). Maintaining telehealth options can become an effective means to improve future health outcomes for at-risk groups, such as YAs with T1D.