The Institute of Medical Science, Asahi Life Foundation, Tokyo, Japan.
J Diabetes Investig. 2022 Sep;13(9):1617-1625. doi: 10.1111/jdi.13826. Epub 2022 May 25.
AIMS/INTRODUCTION: The purpose of this retrospective observational cohort study was to compare outpatient diabetes care and glycated hemoglobin (HbA1c) level during the coronavirus disease 2019 pandemic in 2020 with 2019, and to compare the glucose-lowering effect of telemedicine and clinic visits during the state of emergency in Japan declared from 7 April to 25 May (inter-period) 2020.
A total of 13 weeks before and after the inter-period were designated as the pre-period and post-period, respectively. The number of study participants who had clinic visits during the pre-period and the post-period were 3,333 in 2020 and 3,608 in 2019. Propensity score matching was carried out to compare the effect of telemedicine and clinic visits on diabetes control in 2020 among diabetes patients with insufficient glucose control (HbA1c ≥7%). The primary outcome was post-period HbA1c.
The major difference between 2020 and 2019 was the use of telemedicine in 2020. After adjustment for age, sex, diabetes type, pre-period HbA1c and pre-period body mass index, glycemic control evaluated by HbA1c was significantly worse in the post-period of 2020 than 2019. In the propensity score-matched 618 pairs, the clinic visit group had significantly better post-period HbA1c than the telemedicine group (7.5% vs 7.4%, P = 0.023).
Glycemic control was slightly, but significantly, worse in 2020 than 2019. Although telemedicine significantly improved glycemic control during the coronavirus disease 2019 pandemic in 2020, clinic visits improved HbA1c significantly more. The substitution of telemedicine for clinic visits appears to be a viable option under emergency conditions, but clinic visits might be a better option when possible.
目的/引言：本回顾性观察队列研究旨在比较 2020 年冠状病毒病（COVID-19）大流行期间与 2019 年相比的门诊糖尿病管理和糖化血红蛋白（HbA1c）水平，并比较 2020 年 4 月 7 日至 5 月 25 日日本宣布紧急状态期间远程医疗和门诊就诊对血糖的降低作用。
在该研究中，将干预期前后的 13 周分别指定为预期间和后期间。2020 年预期间和后期间进行门诊就诊的研究参与者人数分别为 3333 人和 3608 人，2019 年分别为 3333 人和 3608 人。采用倾向评分匹配比较 2020 年在血糖控制不足（HbA1c≥7%）的糖尿病患者中，远程医疗和门诊就诊对糖尿病控制的影响。主要结局是后期间的 HbA1c。
2020 年与 2019 年的主要区别在于 2020 年使用了远程医疗。在调整年龄、性别、糖尿病类型、预期间 HbA1c 和预期间体重指数后，2020 年后期间的血糖控制评估 HbA1c 明显差于 2019 年。在倾向评分匹配的 618 对中，门诊就诊组的后期间 HbA1c 明显优于远程医疗组（7.5%比 7.4%，P=0.023）。
2020 年的血糖控制略低于 2019 年，但差异有统计学意义。虽然远程医疗在 2020 年 COVID-19 大流行期间显著改善了血糖控制，但门诊就诊显著改善了 HbA1c。在紧急情况下，替代门诊就诊的远程医疗似乎是可行的选择，但在可能的情况下，门诊就诊可能是更好的选择。
