ABSTRACT
BACKGROUND: Individuals with type 1 diabetes (T1D) are more likely to achieve optimal glycemic management when they have frequent visits with their health care team. There is a potential benefit of frequent, telemedicine interventions as an effective strategy to lower hemoglobin A1c (HbA1c). OBJECTIVE: The objective is this study was to understand the provider- and system-level factors affecting the successful implementation of a virtual care intervention in type 1 diabetes (T1D) clinics. METHODS: Semistructured interviews were conducted with managers and certified diabetes educators (CDEs) at diabetes clinics across Southern Ontario before the COVID-19 pandemic. Deductive analysis was carried out using the Theoretical Domains Framework, followed by mapping to behavior change techniques to inform potential implementation strategies for high-frequency virtual care for T1D. RESULTS: There was considerable intention to deliver high-frequency virtual care to patients with T1D. Participants believed that this model of care could lead to improved patient outcomes and engagement but would likely increase the workload of CDEs. Some felt there were insufficient resources at their site to enable them to participate in the program. Member checking conducted during the pandemic revealed that clinics and staff had already developed strategies to overcome resource barriers to the adoption of virtual care during the pandemic. CONCLUSIONS: Existing enablers for high-frequency virtual care for T1D can be leveraged, and barriers can be overcome with targeted clinical incentives and support.
ABSTRACT
Diabetes incidence is expected to increase following the COVID-pandemic due to widespread changes in physical activity, diet, and access to health care services. We used administrative health care databases from Ontario, Canada to examine monthly changes in diabetes screening during the pandemic (Mar 2020-Feb 2021) compared to the pre-pandemic period (Mar 2019-Feb 2020) among adults aged 20-85 without prior diabetes. The eligible population was 9,599,079 in Mar 20 and 9,941,336 in Feb 2021. Overall, the number of people screened for diabetes was 25.3% lower in the pandemic (N=4,060,348) versus pre-pandemic (N=5,437,284) period. However, the number of people screened each month declined by 65.6% between February and April 2020 (Figure 1;1.53 vs. 4.44 per 100, -2.91 per 100) . Screening rates recovered by July 2020 (3.88 per 100) but remained 15.6% lower than in the pre-pandemic period. Similar patterns were observed in all age groups but declines in screening rates between February and April 2020 were greatest in adults aged 35-49 (-69.4%) and 50-64 (-69.5%) . Findings were also consistent across income groups. In summary, we observed a sudden decline in diabetes screening in Ontario, Canada, where laboratory tests and other health care services are universally insured. This may lead to delays in prediabetes and diabetes diagnosis, resulting in missed opportunities for diabetes prevention and early management.
ABSTRACT
BACKGROUND: Greater risk of adverse health outcomes and public health measures have increased distress among people with diabetes during the coronavirus-2019 (COVID-19) pandemic. The objectives of this study were to explore how the experiences of people with diabetes during the COVID-19 pandemic differ according to sociodemographic characteristics and identify diabetes-related psychosocial correlates of COVID distress. METHODS: Patients with type 1 or 2 diabetes were recruited from clinics and community health centres in Toronto, Ontario, as well as patient networks. Participants were interviewed to explore the experiences of people with diabetes with varied sociodemographic and clinical identities, with respect to wellness (physical, emotional, social, financial, occupational), level of stress and management strategies. Multiple linear regression was used to assess the relationships between diabetes distress, diabetes self-efficacy and resilient coping with COVID distress. RESULTS: Interviews revealed that specific aspects of psychosocial wellness affected by the pandemic, and stress and illness management strategies utilized by people with diabetes differed based on socioeconomic status, gender, type of diabetes and race. Resilient coping (ß=-0.0517; 95% confidence interval [CI], -0.0918 to -0.0116; p=0.012), diabetes distress (ß=0.0260; 95% CI, 0.0149 to 0.0371; p<0.0001) and diabetes self-efficacy (ß=-0.0184; 95% CI, -0.0316 to -0.0052; p=0.007) were significantly associated with COVID distress. CONCLUSIONS: Certain subgroups of people with diabetes have experienced a disproportionate amount of COVID distress. Assessing correlates of COVID distress among people with diabetes will help inform interventions such as diabetes self-management education to address the psychosocial distress caused by the pandemic.