It has been said that necessity is the mother of invention, and the impact COVID-19 has had on the rapid expansion of telemedicine is a prime example. When the COVID-19 pandemic hit, swift action from the Centers for Medicare and Medicaid Services (CMS), as well as private insurers, helped expand the reach of providers. Historically, CMS would only reimburse telemedicine if it was being provided in remote or underserved areas, but the pandemic lifted that requirement as part of the 1135 waiver of the Coronavirus Preparedness and Response Supplemental Appropriations Act. The act authorizes practitioners to provide telehealth, including nurses and dietitians leading Diabetes Self-Management Training, independent of location.
Proponents of telemedicine would argue that this is long overdue. After all, diabetes is well-positioned for this mode of distanced-based care. As a chronic condition that is treated with routine follow-up, a patient can easily share the same vital information remotely with their provider, as they could from a typical face-to-face visit. A quick download of a glucose meter or testing log, along with an A1C level and a video conversation can give the practitioner a pretty clear picture of how the patient is doing. There will be some instances when an in-person visit is necessary, but an established patient with no underlying cardiovascular or neurological comorbidities could fare well with telemedicine.
Previous barriers to care are also removed through the expanded utilization of telehealth. Taking time off of work and traveling to and from appointments are among some of the frequently cited impediments to routine care. Some private insurers also offer a discount on the required copay as a way to further incentivize the service.
In addition to convenience, studies have also shown that telemedicine has produced more favorable outcomes compared to usual care in patients with diabetes. A 2019 meta-analysis from Telemedicine and e-Health featuring data from over 6,000 patients showed significant reductions in A1C levels for patients using telehealth compared to more traditional methods. While researchers agree that telemedicine programs need to be tailored to a patient’s specific requirements, there is ample opportunity to use it as a chance to boost care efforts. Most of the recent research shows that patients with Type 2 diabetes, rather than Type 1, appear to benefit the most from the additional coaching and support made available through widespread telehealth programs.
Helping patients with diabetes understand the facts with regards to COVID-19 can serve as a great segue to those in need of follow-up care. While there is not sufficient data to conclude that infection rates are higher with diabetes, it does appear that poor glycemic control is correlated with poor outcomes based on studies of COVID-19 patients in Wuhan, China. All things being equal, coaching patients to follow the recognized public health measures and helping them achieve glycemic control are the best take-home messages. The expansion of telehealth represents a wonderful opportunity to safely enhance the volume of care and strengthen the performance of a practice.