Closing Disparities in Pediatric Diabetes Telehealth Care: Lessons From Telehealth Necessity During the COVID-19 Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic necessitated using telehealth to bridge the clinical gap, but could increase health disparities. This article reports on a chart review of diabetes telehealth visits occurring before COVID-19, during shelter-in-place orders, and during the reopening period. Visits for children with public insurance and for those who were non-English speaking were identified. Telehealth visits for children with public insurance increased from 26.2% before COVID-19% to 37.3% during shelter-in-place and 34.3% during reopening. Telehealth visits for children who were non-English speaking increased from 3.5% before COVID-19% to 17.5% during shelter-in-place order and remained at 15.0% during reopening. Pandemic-related telehealth expansion included optimization of workflows to include patients with public insurance and those who did not speak English. Increased participation by those groups persisted during the reopening phase, indicating that prioritizing inclusive telehealth workflows can reduce disparities in access to care.

‘Much more convenient, just as effective’: Experiences of starting continuous glucose monitoring remotely following Type 1 diabetes diagnosis

“…9 The SARS-CoV-2 pandemic prompted an accelerated shift to increased telehealth-based diabetes care delivery. 10 As a result, CGM initiation education, previously carried out in-person, also shifted to telehealth-based delivery. However, little is known about how parents and their children experience CGM initiation over telehealth shortly following Type 1 diabetes diagnosis, amidst a period of significant adjustment with a large volume of education delivery.…”

“…The SARS‐CoV‐2 pandemic prompted an accelerated shift to increased telehealth‐based diabetes care delivery 10 . As a result, CGM initiation education, previously carried out in‐person, also shifted to telehealth‐based delivery.…”

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes

“…The recent COVID‐19 global pandemic, and increased opportunities for the use of video or phone appointments between a person with diabetes and/or their carer and the health care professional, has highlighted the utility of CGM metrics to assess glycemia when laboratory measurement of HbA1 c level is not available. While disparities also exist for accessing telemedicine including implicit bias, well‐developed work plans can expand the population who can benefit from this health delivery method 15 . Nevertheless, not all young people can access CGM and are reliant on SMBG and/or HbA1c measurement.…”

Tele-education model for primary care providers to advance diabetes equity: Findings from Project ECHO Diabetes

“…During the COVID-19 pandemic, increase in telehealth utilization, where the endocrinology subspecialty provider engages in direct patient care and management, has become a more commonplace and well-accepted (13)(14)(15). While this model has been considered useful in increasing the access to subspecialty care, barriers to telehealth utilization have included limitations due to English proficiency, health literacy, technology access, and broadband/connectivity issues (16)(17)(18).…”

“…In addition to the shortage of pediatric and adult endocrinology providers, the incidence and prevalence of pediatric and adult diabetes is increasing which further exacerbates the access gap, particularly for underrepresented populations (22)(23)(24). The COVID-19 pandemic accelerated telehealth implementation for nearly all diagnoses such that telemedicine is now considered a standard modality for health care delivery (13,14,25,26). That said, telehealth alone is not sufficient to ensure access to standard of care for many individuals living with diabetes.…”