1390-P: Access to Telehealth and Changes in Diabetes Care Patterns during the Pandemic

Objective: To investigate the impact of the COVID-19 pandemic on telehealth utilization and adherence to annual diabetes care guidelines and risk factor management among people with diabetes.

Research Design and Methods: We included all adults (≥18 years) with prevalent diabetes as of January 1, 2018, who were continuously enrolled at Kaiser Permanente Georgia (KPGA) through December 31, 2021 (n=22,854). We defined pre (2018-2019) and during COVID-19 (2020-2021) periods. Logistic generalized estimating equations (GEE) were used to assess the within-subject change in screening adherence (blood pressure (BP), HbA1c, cholesterol, creatinine, urine-albumin-creatinine ratio, eye and foot exam) pre and during COVID-19 among telehealth users (i.e., at least one telehealth visits per period) and non-telehealth users. Linear GEE similarly compared mean lab measurements pre vs. during COVID-19, stratified by telehealth use.

Results: The proportion of telehealth users increased from 38.7% to 91.5% pre vs. during COVID-19. During the pandemic, adherence to all annual screenings declined but the decline was significantly less in telehealth (range: 1.6% for foot exams to 12.4% for BP) vs. non telehealth users (range: 1.9% for foot exams to 40.7% for BP). Average HbA1c, BP, creatinine, and UACR worsened during (vs. pre) COVID-19, while LDL cholesterol improved, and this effect was greater in non-telehealth users.

Conclusion: The proportion of people with diabetes meeting guideline recommended screenings decreased during the pandemic, coinciding with worsening glucose, kidney, and (some) cardiovascular risk profiles, and was more severe for non-telehealth users. Follow-up is needed to assess the long-term implications and the role of telehealth use in addressing these care gaps.