1062-P: Impact of COVID-Related Clinic Disruption in Patients with Type 2 Diabetes

State of Illinois stay-at-home orders March 21-August 31, 2020 required a shift to telehealth appointments. Behaviors during COVID lockdowns adverse to glycemic management are documented, but studies of clinic disruptions on glycemic control are lacking. This is a retrospective study of adults (N = 171, age ≥ 18 y) with insulin-treated type 2 diabetes mellitus managed for at least one year prior to stay-at-home orders. Patients were seen at least once in the following intervals: Baseline 1 (March 21-August 31, 2019, 1-y before lockdown), Baseline 2 (September 1-November 30, 2019, 1-y before end of lockdown), Study 1 (March 21-August 31, 2020, lockdown), and Study 2 (September 1-November 30, 2020, immediately after lockdown). Primary endpoint was glycemic control measured by HbA1c. Nearly all appointments (97.6%) during Baseline 1, Baseline 2, and Study 2 were in-person, and appointments during Study 1 were both in-person (67.8%) and telehealth (32.2%) [P < 0.0001 for comparison of Baseline 1, Baseline 2, and Study 2 to Study 1]. HbA1c improved from Baseline 1 (8.9 ± 1.7%) to Baseline 2 (8.5 ± 1.8%) to Study 1 (8.3 ± 1.6%), with P = 0.004 for the trend. HbA1c increased to 8.6 ± 1.9% during Study 2 (P = 0.07 compared to Study 1). Study 1 in-person and telehealth appointment subgroups had equivalent increases in HbA1c from Study 1 to Study 2. There was no difference in insulin dose adjustments or use of non-insulin therapeutics between the Study 1 subgroups. Other clinical parameters were similar between subgroups; however, systolic blood pressure (SBP) during Study 2 was significantly lower for patients seen in-office during Study 1 compared to Study 1 telehealth patients (128.9 ± 17.7 mm Hg vs. 137.0 ± 18.1 mm Hg, P = 0.008). There was no significant effect of telehealth appointments during pandemic lockdown on glycemic control compared to patients seen in-office, though patients seen in-office had significantly better control of SBP than telehealth patients.