Virtual Consultations and the Role of Technology During the COVID-19 Pandemic for People With Type 2 Diabetes: The UK Perspective

Abstract

The coronavirus disease (COVID-19) pandemic has presented unique challenges for people with diabetes, in addition to their high-risk stratification for infection. Supporting people with diabetes to self-care has been critical to reduce their risk of severe infection. This global pandemic has presented an opportunity to digitalize diabetes care and rapidly implement virtual diabetes clinics, with the aim of optimizing diabetes management and well-being, while keeping patients safe. We performed a rapid review of the literature to evaluate the feasibility and effectiveness of virtual clinics in diabetes care before and during the COVID-19 pandemic and have combined these findings with our own reflections in practice. We identified examples demonstrating safety and feasibility of virtual diabetes clinics, which aligns with our own clinical experience during the pandemic. The advantages of virtual clinics include reduced treatment burden, improved therapeutic alliances, societal and psychological benefits, and in our experience, innovative solutions to overcome the challenges presented by the transition from in-person to virtual care. We have provided three infographics to illustrate lessons learned and key recommendations, including steps to establish a virtual diabetes clinic, a checklist guide for health care professionals conducting virtual clinics, and a patient guide for making the most out of the virtual clinic. It is important to continue adapting to this pandemic and to make technology a sustainable option for the future of diabetes care.

A perspective piece on Diabetes Self-Management Education and Support (DSMES) programmes for under-represented groups with T2DM in the UK

“…Health technology has evolved over the last two decades and sources such as digital self-management programmes are now used as supplementary and/or stand-alone sources for knowledge and emotional/social support in the management of chronic conditions. [58][59][60][61] Indeed, an incline in the adoption of digital health education has been observed during the coronavirus pandemic and our group have previously reported on the value of digital health in diabetes care and self-management. 60 Despite the rise of digital DSMES programmes, evaluation of this form of support reveals equivocal results; some studies report improvements solely on biomedical outcomes, such as HbA1c , 62,63 while other studies report improvements in psychological outcomes.…”

“…[58][59][60][61] Indeed, an incline in the adoption of digital health education has been observed during the coronavirus pandemic and our group have previously reported on the value of digital health in diabetes care and self-management. 60 Despite the rise of digital DSMES programmes, evaluation of this form of support reveals equivocal results; some studies report improvements solely on biomedical outcomes, such as HbA1c , 62,63 while other studies report improvements in psychological outcomes. 64 However, the evidence on psychological outcomes remains scarce, with recent systematic reviews presenting conflicting results and suggesting no significant difference in outcomes such as diabetes-related distress and depression.…”

Changing media depictions of remote consulting in COVID-19: analysis of UK newspapers

“… 13 – 17 Empirical evaluations of new telehealth services were quickly produced, and largely emphasised the benefits of such services. 18 – 21 Review articles and commentaries depicted such services as part of a wider digital response to the pandemic, which also included new and repurposed technologies for population surveillance, case identification, contact tracing, point-of-care diagnosis, and disease monitoring. 22 , 23 In short, policymakers and researchers as well as journalists appear to have placed considerable faith in the power of technology to respond to the virus.…”

COVID-19 and beyond: virtual consultations in primary care—reflecting on the evidence base for implementation and ensuring reach: commentary article

“…47 However, virtual consultations do pose challenges to primary care staff in diagnosing and managing more complex/chronic conditions or multimorbidities. 3 30 Although we know some service user groups-such as those with type 2 diabetes-have been early adopters of both digital/online access to medical records and virtual consultations, [50][51][52] there is still relatively little known about the need for efficiency and sustainability of this type of contact for different service user groups, conditions and across geographically diverse areas. 22 This research agenda can only be met by co-design studies with the central involvement of clinicians, a range of staff and service users across geographically diverse areas, to prioritise the research agenda, co-create more equitable systems and disseminate these practices.…”