Shift to Virtual Visits for Veterans with Type 2 Diabetes During the Pandemic Was Not Associated with Adverse Outcomes
During the COVID-19 pandemic, healthcare resources were shifted away from chronic disease management to support intensive care expansions. People with type 2 diabetes experienced changes in the frequency of visits and lab tests as well as visit modality (virtual vs. in-person). This observational study sought to describe the changes in management, control, and outcomes in older people with type 2 diabetes (T2D) associated with the shift from in-person to virtual visits. Investigators identified 740,602 Veterans who were 65 years or older, had T2D, used VA healthcare between October 1, 2013 and September 30, 2015, and were still active users between January 1, 2018 and December 31, 2019, with follow-up data through 2020. Investigators assessed visits (in-person, virtual, total), A1c measurement, deintensification/intensification of antidiabetic treatment, ER visits, hospitalization rates, and A1c level for each month between July 2018 and November 2020. To assess the impact of the pandemic, investigators compared the rates in March 2020 (pandemic declaration month), and April-November 2020 (pandemic period), to a pre-pandemic period of July 2018 to February 2020.
- Relative to baseline, among the 740,602 Veterans in this study, there were 55% fewer in-person visits and 824% more virtual visits, with a net result of 10% more total visits during the pandemic relative to the pre-pandemic period. There also were 6% fewer A1c measurements, and 14% more treatment intensifications.
- Despite a shift to virtual visits and decreased A1c measurement rates during the pandemic, no association with A1c level or short-term T2D-related outcomes (i.e., ER visit or hospitalization for hypo or hyperglycemia) was observed, providing some reassurance about the adequacy of virtual visits.
- Further studies should assess the longer-term effects of shifting to virtual visits in specific patients to help individualize care and maintain appropriate care while reducing overuse.
- This study could not distinguish between deintensification due to a clinician decision vs. patient non-adherence. Further, Medicare data were not yet available, thus ER visits and hospitalizations outside VA were not captured. This study could not account for other factors that may have affected outcomes, such as modifications in diet or physical activity related to social distancing.
This study was funded by HSR&D (IIR 15-131). All authors are part of HSR&D’s Center for Clinical Management Research (CCMR), Ann Arbor, MI.
Aubert C, Henderson J, Kerr E, Holleman R, Klamerus M, and Hofer T. Type 2 Diabetes Management, Control and Outcomes During the COVID-19 Pandemic in Older US Veterans: An Observational Study. Journal of General Internal Medicine. January 6, 2022;1-8: online ahead of print.