Digital diabetes care: How well equipped are patients and what do they think about it

Aims: Covid-19 precipitated an abrupt shift to non-face- to- face (digital) consultation. Some believe that this was overdue and that digital is better for many patients. Our aim was to establish the extent to which people with diabetes were equipped to manage digital consultation and what they felt about it. Methods: We surveyed 1,000 people with diabetes (500 type 1, 500 type 2) from our local, largely deprived community with a user-approved questionnaire, tested for face validity and readability. Results: Response rate was 376/1000 (38%);132 (35%) type 1 diabetes, 218 (58%) type 2 diabetes, 1% other and 6% blank. Age of respondents was: ≤30, 0%;31-40, 4%;41-50, 7%;51-60, 12%;61-70, 17%;71-80, 52%;81-90, 3%;and blank, 5%. Treatment was: diet alone, 11%;diet and tablets, 39%;diet and insulin injections, 24%;diet, tablets and glucagon-like peptide-1 receptor agonist, 2%;insulin pump, 9%;and blank, 6%. Some 22% were attending the hospital clinic;74% not and 4% blank. Only 40% patients had access to a video calling device and only 35% had ever used it. Separate Likert scales showed: 79% strongly preferred or preferred face-to- face consultation, 17% strongly preferred or preferred telephone;and only 6% strongly preferred or preferred video consultation;66% recognised limitations in examination, weight and blood pressure checks with digital. Summary: Our survey, representative of type 1 and type 2 diabetes and of all treatment modalities but with underrepresentation of very young respondents, reveals that most patients did not have equipment for digital consultation and 79% preferred face-to- face consultation.

Covid-19 pandemic associated with three-fold increase in demand for diabetes specialist advice

Aims: The covid-19 pandemic was associated with legally restricted public movement (lockdowns) and reduced access to face-to- face consultation for diabetes in primary and specialist care. The aim of this study was to assess the impact of the pandemic on requests for specialist telephone support. Methods: Retrospective analysis of calls for telephone support before and during the covid-19 pandemic via three separate extensions tailored to specific needs: (1) diabetes emergency advice line (direct diabetes specialist emergency advice 08.00-20.00, Monday to Friday and 08.00-16.00 Saturday and Sunday);(2) diabetes general advice line (a 24/7 telephone answer machine, typically used by patients and carers, answered repeatedly Monday to Friday 08.00-18.00);and (3) a diabetes community line, typically used by healthcare professionals in the community. We arbitrarily defined 'pre-covid' as calls up to 31/3/20 and 'during covid' as calls thereafter to 1/5/21. Results: Mean ( ± SD) calls per calendar month (pcm) increased highly significantly: 81 ( ± 80) pcm pre-covid to 248 ( ± 72) pcm during covid, p < 0.001. Emergency advice line calls did not increase: 15 ( ± 5) pcm pre-covid to 18 ( ± 11) during covid, p = 0.9, general advice line calls increased non-significantly: 161 ( ± 19) to 194 ( ± 68), p = 0.1, but community calls increased highly significantly: 16 ( ± 6) to 36 ( ± 12), p < 0.001. Although calls rose during lockdowns, the monthly picture was more of a sustained increase after the first lockdown. Summary: The covid-19 pandemic has been associated with a sustained increase in requests for non-emergency diabetes specialist team advice, particularly from primary care professionals in the community.