Diabetes management by either telemedicine or clinic visit improved glycemic control during the coronavirus disease 2019 pandemic state of emergency in Japan

Abstract

The purpose of this retrospective cohort study at a Tokyo diabetes clinic was to evaluate the effect of telemedicine and clinic visit on glycated hemoglobin (HbA1c) during the coronavirus disease 2019 state of emergency. The effect of telemedicine and clinic visit during the emergency period on the post‐emergency measured HbA1c was evaluated by multiple regression models and logistic regression models adjusted for age, sex, type of diabetes, pre‐emergency HbA1c and body mass index, and body mass index change during the emergency period. Among 2,727 patients who visited the clinic before and after the emergency period, the interval between clinic visits during the emergency period was significantly associated with HbA1c improvement. Telemedicine and clinic visit were independently associated with HbA1c improvement when pre‐emergency HbA1c was ≥7%. In conclusion, clinic visit and telemedicine during the coronavirus disease 2019 emergency period were both independently effective in HbA1c improvement in Japanese diabetes patients who had insufficient HbA1c control.

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“…A switch to remote consultations, delivered either via phone or video calls, during strict lockdowns has been linked with reduced HbA1c. 18 Similarly, pairing flash glucose monitoring with remote control has shown promising outcomes. 19 However, discrepancies among healthcare systems across countries must be taken into account.…”

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“…Moreover, a recent meta-analysis by Correia and colleagues, 36 which focused on telemedicine interventions implemented in low- and middle-income countries, indicated that telemedicine interventions were effective for diabetes management and resulted in significant reductions in HbA1c levels (standardized mean differences = −0.38, 95% CI = −0.52 to −0.23). In a study from Japan, Onishi and colleagues 39 reported that among patients with diabetes having HbA1c ⩾ 7% before the pandemic outbreak, providing diabetes care through telemedicine during the state of emergency resulted in an improvement to HbA1c < 7% after the emergency period in Japan. In addition to the clinical benefit, the patients on telecare also reported feeling more secure and more care, and the telecare helped the patients and their families take more active roles in their diabetes self-care management.…”

“…[30][31][32] Before the pandemic, many studies indicated the clinical effectiveness of telemedicine in diabetes care, including significant and clinically relevant reductions in HbA1c. [31][32][33][34][35][36][37][38] Moreover, during the COVID-19 pandemic, two studies from Japan 39 and Saudi Arabia 40 reported similar positive clinical outcomes in terms of glycemic control. In addition, it has been shown that increasing patient contact through frequent phone calls improves patient therapy adherence, motivation, and metabolic control.…”

Impact of the COVID-19 Pandemic on Management of Children and Adolescents with Type 1 Diabetes

“…Adoption of telemedicine visits may improve outcomes in diabetic patients; retrospective data during the COVID-19 pandemic in 2727 Japanese diabetes patients showed both telemedicine and clinic visits improved glucose control (13). However, in a report of 28,977 patient visits over 2.5 years at a single US center, the odds of completing a visit via telemedicine were lower among non-English speaking and Medicaid insured pediatric patients.…”