Despite the increase in telehealth services in diabetes care during the COVID-pandemic, studies have found disparities in telemedicine (TM) use among patients. Our Diabetes Clinic currently cares for 1400 patients with type 1 diabetes (T1D) with 46% being publicly insured and for 375 patients with type 2 diabetes (T2D) , 88% being publicly insured. We have previously shown a significantly lower number of completed TM encounters between March and July 2020 by publicly insured patients when compared with privately insured and a threefold increase in no-shows and same day TM visit cancelations by the publicly insured group. Between January and March 2021 we surveyed families who had never attended a TM visit to better understand barriers to TM use. Of the 7patients who received care during this period, 162 (22.8%) had never attended a TM visit. Of the 39 surveyed patients, 84.6% had T1D and 15.4% had T2D. There were 46.2% who self-identified as Non-Hispanic White, 35.9% as Hispanic, 5.1% as Asian, 2.6% as Non-Hispanic Black, and 10.3% as Other. Additionally, 48.7% had public insurance, 23.1% had no EMR access and 15.4% did not speak English as their primary language. Out of patients with T1D, 63.6% used a CGM and 33.3% used an insulin pump. Reported reasons not to attend a TM visit included: preference for in-person care (43.6%) , not being offered a TM visit (17.9%) , technology issues (12.8%) , scheduling conflicts or forgetting about the appointment (17.9%) and 20.5% preferred not to provide a reason.
In conclusion, more than half of our surveyed patients with diabetes who never attended a TM visit were from racial and ethnic minority groups. The COVID-pandemic has highlighted disparities related to access to and use of technology to improve diabetes care. Our results show the importance of ensuring all families are aware of TM options and receive support with TM technology. Further research into TM perception and adoption barriers should be conducted to prevent disparities in care and to close health equity gaps.
K.Chan: None. C.Demeterco-berggren: None.