Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
BMJ Open Diabetes Res Care. 2024 Feb 27;12(1):e003882. doi: 10.1136/bmjdrc-2023-003882.
To examine the role of telehealth in diabetes care and management during versus pre-COVID-19 pandemic.
We included adults (≥18 years) with prevalent diabetes as of January 1, 2018, and continuously enrolled at Kaiser Permanente Georgia through December 31, 2021 (n=22,854). We defined pre (2018-2019) and during COVID-19 (2020-2021) periods. Logistic generalized estimating equations (GEEs) assessed the within-subject change in adherence to seven annual routine care processes (blood pressure (BP), hemoglobin A1C (HbA1c), cholesterol, creatinine, urine-albumin-creatinine ratio (UACR), eye and foot examinations) pre versus during COVID-19 among telehealth users (ie, more than one telehealth visit per year per period) and non-telehealth users. Linear GEE compared mean laboratory measurements pre versus during COVID-19 by telehealth use.
The proportion of telehealth users increased from 38.7% (2018-2019) to 91.5% (2020-2021). During (vs pre) the pandemic, adherence to all care processes declined in telehealth (range: 1.6% for foot examinations to 12.4% for BP) and non-telehealth users (range: 1.9% for foot examinations to 40.7% for BP). In telehealth users, average HbA1c (mean difference: 0.4% (95% CI 0.2% to 0.6%), systolic BP (1.62 mm Hg (1.44 to 1.81)), and creatinine (0.03 mg/dL (0.02 to 0.04)), worsened during (vs pre) COVID-19, while low density lipoprotein (LDL) cholesterol improved (-9.08 mg/dL (-9.77 to -8.39)). For UACR, odds of elevated risk of kidney disease increased by 48% (OR 1.48 (1.36-1.62)). Patterns were similar in non-telehealth users.
Telehealth use increased during the pandemic and alleviated some of the observed declines in routine diabetes care and management.
研究目的在于探讨远程医疗在新冠疫情大流行前后糖尿病护理及管理中的作用。
我们纳入了 2018 年 1 月 1 日至 2021 年 12 月 31 日期间在佐治亚州 Kaiser Permanente 连续登记在册的年龄≥18 岁的成年糖尿病患者（n=22854）。我们定义了前（2018-2019 年）和新冠疫情期间（2020-2021 年）两个时间段。使用对数广义估计方程（GEE）评估了在远程医疗使用者（即每年每个时间段至少有一次远程医疗就诊）和非远程医疗使用者中，七个年度常规护理流程（血压（BP）、糖化血红蛋白（HbA1c）、胆固醇、肌酐、尿白蛋白肌酐比（UACR）、眼睛和足部检查）在新冠疫情前与期间的依从性变化。线性 GEE 比较了新冠疫情期间远程医疗使用前后实验室检测指标的平均值。
远程医疗使用者的比例从 2018-2019 年的 38.7%增加到 2020-2021 年的 91.5%。在大流行期间，所有护理流程的依从性在远程医疗使用者（足部检查的依从性下降 1.6%，BP 下降 12.4%）和非远程医疗使用者（足部检查的依从性下降 1.9%，BP 下降 40.7%）中均有所下降。在远程医疗使用者中，HbA1c（平均差异：0.4%（95%CI 0.2%至 0.6%）、收缩压（1.62 毫米汞柱（1.44 至 1.81））和肌酐（0.03 毫克/分升（0.02 至 0.04））在新冠疫情期间恶化，而低密度脂蛋白胆固醇（LDL-C）则有所改善（-9.08 毫克/分升（-9.77 至-8.39））。对于 UACR，患肾脏疾病风险增加的几率增加了 48%（OR 1.48（1.36-1.62））。非远程医疗使用者中也存在类似的模式。
远程医疗的使用在大流行期间有所增加，并缓解了观察到的一些常规糖尿病护理和管理的下降。
