Telemedicine Use and Decrements to Type 2 Diabetes and Hypertension Care during the COVID-19 Pandemic

Abstract Background: We examine pandemic-era quality of care changes associated with telemedicine use among adults with type 2 diabetes and/or hypertension across ten health systems. Methods: Patient-level encounter and laboratory data (n=1,963,563) were analyzed for pre-pandemic (March 13, 2019 to December 31, 2019) and pandemic (March 13, 2020 to December 31, 2020) periods. Generalized linear models with binomial distribution functions and log links estimated the association of telemedicine use with four outcomes: 1) hemoglobin A1c (HbA1c) testing, 2) HbA1c control (<8.0%), 3) blood pressure (BP) testing, and 4) BP control (<140 / 90 mmHg), controlling for patient characteristics, system fixed effects, and with propensity score weights. Results: In adjusted analyses, telemedicine use was associated with lower odds of HbA1c (aOR=0.74, p<0.05) and BP (aOR=0.40, p<0.01) testing for adults with type 2 diabetes, but not HbA1c or BP control. Among hypertension-only patients, telemedicine use was associated with lower odds of BP testing (aOR=0.10, p<0.001), but not BP control. Compared to pre-pandemic telemedicine use, pandemic period telemedicine use was associated with lower odds of HbA1c and BP monitoring. Discussion: Telemedicine use was associated with lower odds of HbA1c monitoring for adults with type 2 diabetes and lower odds of BP testing for adults with type 2 diabetes and/or hypertension. Conclusion: As telemedicine continues to be used for diabetes and hypertension care, remote monitoring, standing orders, and community pharmacy partnerships may be necessary supplements to telemedicine to assure high quality care, especially when in-person care options are limited.