Impact of COVID-19 on A1c Management and Telehealth Use Among a Type 2 Diabetes Mellitus Population in the Outpatient Setting.

Abstract

Background: The COVID-19 pandemic disrupted routine healthcare delivery, raising concerns about chronic disease management, particularly for individuals with type 2 diabetes mellitus (T2DM). This study evaluated the pandemic's impact on glycemic control and telehealth utilization in an underserved outpatient population.

Methods: A retrospective cohort analysis used de-identified electronic health record and claims data from a family medicine clinic in central Texas. The study included 387 adults with T2DM who had at least one A1c measurement in both the pre-pandemic period (1 March 2019-13 March 2020) and COVID-19 era (14 March 2020-31 March 2021). Outcomes included A1c control (<8.0%), prescription trends, and telehealth use. A case series examined individual-level patterns.

Results: A significantly higher percentage of patients achieved A1c control during the COVID-19 era (75.2%) compared to the pre-pandemic period (68.7%, p < 0.05), despite a decline in prescriptions for diabetes medications and supplies. Telehealth visits increased substantially. Patients who maintained or improved glycemic control often had uninterrupted access to medications and telehealth.

Conclusion: This study is novel in its focus on a safety-net outpatient clinic serving a predominantly low-income, diverse population in central Texas, an underserved group often underrepresented in diabetes research. By combining a retrospective cohort analysis with a descriptive case series, the study offers both population-level trends and individual-level insights into how medication access and telehealth engagement influenced glycemic control during the pandemic. These findings highlight the potential of telehealth to support diabetes management during healthcare disruptions and underscore the importance of maintaining medication access in vulnerable populations.