Telemedicine Visit Use and Glycemic Control in Patients With Diabetes

Context Endocrinology telemedicine visits increased during the COVID-19 pandemic with unclear impacts on patient outcomes. Objective To determine the relationship between different rates and types of telemedicine use and glycemic control in patients with diabetes. Methods This was a retrospective cohort study conducted in endocrinology clinics at an integrated health system. Patients were adults with a baseline glycated hemoglobin (HbA1c) measurement in 2020, at least 2 diabetes visits in 2021, and an outcome HbA1c assessment in 2022. The proportion of total visits in 2021 conducted by video or phone was analyzed and the primary outcome was the change in HbA1c between baseline and the 2022 assessment. Results The study population (n = 8867) was 51.39% female, with a mean age of 63.90 years and baseline HbA1c of 7.72%. Patients had a mean of 35.09% telemedicine visits in 2021 (25.18% video, 9.91% phone). Between 2020 and 2022, HbA1c decreased by a mean of 0.17%. Multivariable regression analysis adjusted for demographic and clinical covariates demonstrated that higher rates of phone (P = .009) but not video visits were associated with a smaller decrease in HbA1c. When stratified by baseline HbA1c, higher rates of phone visits were associated with a smaller decrease in HbA1c in patients with a baseline HbA1c >= 8.0% (P = .001) but not in those with a baseline HbA1c < 8.0%. Conclusion Higher rates of phone but not video visits were associated with worse glycemic control in patients with higher baseline HbA1c. Additional research is needed to determine possible causes and strategies for bridging the digital divide.