Aim: The COVID-19 pandemic highlighted potential healthcare misalignment as seen by vaccine rates. We investigated pediatric diabetes visit frequency in patients living in lower vs. higher COVID 19 vaccination areas.

Method: We obtained EHR-extracted visit data for youth with T1D, ≤18 years old, with ≥1 visit in both the pre-pandemic (9/15/18-3/15/20) and pandemic (4/1/20-12/31/21) period. Residential addresses were geocoded and linked with CDC county level COVID vaccination data from 2/2/2022. High vaccine counties were defined as those in which ≥75% of the population ages 12 and older were fully vaccinated. We performed paired t-tests and logistic regression. Models were adjusted for age, gender, pre-pandemic A1c, and diabetes duration.

Results: There were 1,029 youth (49% female, pre-pandemic age 13.7±3.8 yrs, T1D duration 6.7±4.3 yrs) who had clinical encounters in both periods. 541 youth were from high vaccine counties. There was no difference in age, gender, T1D duration, CGM or pump use, or baseline A1c between youth from high vs. low vaccine counties. Overall there was increased visit frequency in the pandemic (5.1±3.0) vs. pre-pandemic (4.7±2.6) (p=0.03) . The mode of visits shifted from in person to virtual during the pandemic (p<0.001) . In adjusted models, there was no association between county-level COVID vaccination coverage and visit frequency (OR 1.03, 95% CI 0.99-1.07) .

Conclusion: The COVID 19 pandemic resulted in a shift in care delivery to telehealth. Telehealth allowed for increased visit frequency. Patients coming from low COVID 19 vaccination counties attended diabetes visits as frequently as those coming from high COVID vaccination counties. County COVID vaccine status did not impact visit frequency of a chronic condition.


S. Ojukwu: None. A. Adam: None. T. Kaushal: None. C. Chen: None. L. J. Tinsley: None. L. K. Volkening: None. L. M. Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.


National Institutes of Health (K12DK094721, P30DK036836)

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