943-P: Impact of Culturally Appropriate Diabetes Care amongst Asian Americans with Type 2 Diabetes during the COVID Pandemic

Even as patients with T2D have been shown to have increased COVID-related morbidity and mortality, little is known on the impact of COVID on appointment adherence. This report reviews the impact of culturally-relevant diabetes clinics on adherence to clinical appointments, (pre-and during COVID) . This is a retrospective observational study using EMR data of adult patients with T2D managed at Joslin Diabetes Center before the COVID pandemic (April 20to Dec. 2019) and during the COVID pandemic (April 2020 to Dec. 2020) . Demographic and clinical visit data were extracted from patients seen at least once in both time periods. Clinical appointment adherence and outcomes were compared to patients in the general adult diabetes clinic (GADC) versus the Asian American Diabetes Initiative clinic (AADI) . 297 adult patients with T2D were seen in the AADI clinic and 4,655 patients were seen in the GADC clinics. The AADI clinic catered to a significantly larger proportion of patients who were non-native English speaking (46.1% vs. 8.7%, p<0.001) and on Medicaid (8.4% vs. 4.6%, p<0.001) . Early in the pandemic, virtual appointments were the major source of kept visits, with in-person kept appointments adherence returning in late 2020 (Oct-Dec.) . While the AADI clinic saw no significant changes in kept appointment rates, the GADC clinic had significantly fewer kept appointments overall compared to a similar time frame pre-COVID (pre: 71.7% vs. during: 63.5%, p=0.03) . Both clinics had significantly higher no-show rates during the pandemic. Comparing clinical outcomes, while GADC clinic patients saw a decline in their eGFR during the pandemic (80 vs. 75; p-value=0.04) , the AADI clinic did not observe a significant change in their patient’s renal status (82 vs. 83; p-value=0.93) . Our study shows that culturally oriented clinics like the AADI can successfully allow lower-incomes and older adults to acclimatize to telehealth services while also ensuring ongoing clinical wellbeing