Diabetes Care and Glycemic Control During the COVID-19 Pandemic in the United States

There were 1 357 029 and 1 364 522 adults with diabetes in the 2019 and 2020 cohorts, respectively, with similar baseline characteristics (Table). In 2019, 0.3% of cohort had 1 or more telemedicine visit, compared with 29.1% of the 2020 cohort during the pandemic period.

During the prepandemic period, there was no clinically meaningful difference between the cohorts across all 6 outcome measures (Figure). Early in the pandemic period, there were large reductions in visits and testing that rebounded to near-baseline levels by week 48. Across the entire pandemic period, adjusted use was lower in 2020 compared with 2019 for outpatient visits (85.0% vs 87.3% of patients in 2020 and 2019 cohorts with ≥1 outpatient visit during pandemic period; relative percent change −2.6%), HbA_1c testing (76.5% vs 81.8%; −6.5%), retinopathy testing (5.6% vs 6.9%; −18.8%), and nephropathy testing (40.1% vs 43.9%; −8.5%). In contrast, medication fill rates were similar during the pandemic period of 2020 as compared with 2019 (64.2% vs 62.2%; 3.6%). Levels of HbA_1c were nearly identical during the pandemic period of 2020 compared with 2019 (7.16% vs 7.14%; 0.3%). Due to sample size, all comparisons between 2020 and 2019 were statistically significant at P < .001.

While diabetes-related outpatient visits and testing fell during the pandemic, we observed no evidence of a negative association with medication fills or glycemic control. One explanation for these patterns could be the small increase in medication fill rates during the pandemic that may have protected against any disruptions in diabetes self-management during the pandemic and hence staved off detrimental effects on glycemic control. Mail-order pharmacies and pharmacy delivery services may have been key during the pandemic in ensuring patients receive their medications. Together, these would be consistent with diabetes disaster preparedness guidelines, which emphasize prioritizing access to medications over access to health care professionals during an emergency.⁶

The unprecedented increase in telemedicine visits we observe during the pandemic, although unable to overcome the overall decrease in visits, may have prevented substantive disruptions in medication prescribing. Our findings also emphasize that there is not a direct relationship between visit frequency and glycemic control. Limitations of our findings include that the results may not generalize to other populations such as those with Medicaid insurance or the uninsured.

View the study here: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781811