1078-P: The Impact of Telemedicine Use on Subsequent Glycemic Control in Patients with Diabetes

Introduction & Objective: Telemedicine visits increased significantly during the COVID-19 pandemic, particularly in endocrinology. While many providers continue to use telemedicine, its impact on patient outcomes remains uncertain. This study sought to determine the effect of varying levels of telemedicine use on clinical outcomes in patients with diabetes.

Methods: In this retrospective observational study, we examined the relationship between telemedicine use and glycemic control in patients seen by endocrinology for diabetes at an integrated health system. Patients were included if they had a baseline HbA1c in 2020, at least two visits for diabetes in 2021, and an outcome HbA1c in 2022.

Results: The study population (n=9,195) was 51.3% female with a mean age 63.9 (SD 13.7) years and baseline HbA1c 7.7% (SD 1.5). Patients had a mean of 34.8% (SD 39.0) telemedicine visits in 2021. Between 2020 and 2022, HbA1c decreased by a mean of 0.17% (SD 1.39). In univariate ANOVA analysis, HbA1c decreased by 0.19% (SD 1.37) in patients with no telemedicine use, 0.18% (SD 1.39) in patients with both telemedicine and in-person visits, and 0.09% (SD 1.4) in patients with only telemedicine visits (p = 0.047). In a multivariable linear regression model adjusted for patient demographics, baseline HbA1c and renal function, diabetes type, insulin use, and comorbidities, a higher percentage of telemedicine use was associated with a lower decrease in HbA1c (coefficient = 0.11, 95% CI 0.03 - 0.18, p = 0.003). Older age and insulin use were also associated with a lower decrease in HbA1c, while being partnered, completing at least some college, public insurance, Type 1 DM, higher BMI, and higher baseline HbA1c were associated with a greater HbA1c decrease.

Conclusion: Patients with a high percentage of telemedicine use may have worse glycemic control. Additional research is needed to determine the possible causes for this finding and strategies for delivering effective telemedicine care for patients with diabetes.