ABSTRACT
Background and Aims: Diabetes is one of the most financially burdensome diseases in the U.S., and the COVID-19 pandemic has exacerbated financial stress among people with diabetes (PWD). This study investigated how finances have impacted diabetes care from June 2020 to June 2021. Methods: In June 2021, 4,780 adults living with diabetes in the U.S. completed an online survey in which they reported the influence of finances on their diabetes care on a scale of 1 to 5 and whether they delayed medical care due to cost in the last year. Respondents who reported delaying their medical care due to cost (n = 759) were asked in which ways they delayed care. Results: Finances have a significant influence on diabetes care for 24% of respondents. In the last year, 13% of PWD delayed care due to cost, and those in lower income brackets were more likely to delay care. Among those who delayed care, 48% of CGM users delayed ordering CGM supplies and 30% of CGM users delayed starting on a new diabetes device. Half of respondents using a pump delayed ordering pump supplies. Among those on MDI, 50% delayed an insulin refill compared to 38% of respondents using a pump. Conclusions: At a time when high costs of care are intersecting with pandemic-related financial stress, PWD are postponing care and delaying orders of necessary supplies, which may lead to further health complications. COVID-19 has amplified the need for policy and industry to take action to ensure PWD can access the care and supplies they need to live.
ABSTRACT
Objective: The rapid rise of telemedicine, necessitated by the COVID-19 pandemic, has changed how care is administered and created additional burdens for healthcare professionals. This study investigated how Diabetes Care and Education Specialists (DCES) have implemented telemedicine in their practices to identify possible areas for improvement. Method: 350 DCES from an opted-in US research panel were surveyed. Respondents were asked about their expected and present use of telemedicine, satisfaction with telemedicine versus in-person appointments, and perceived changes in the frequency of treatment decisions made over telemedicine compared to in-person. Result: On average, respondents reported that 57% of appointments were conducted using telemedicine this year and estimated a decrease in telemedicine use during 2021 (41%). While 67% of respondents were satisfied with in-person visits (selecting a 9 or 10 on a 10-point scale), just 25% were satisfied with telemedicine visits. Analysis of verbatim comments revealed dissatisfaction with telemedicine stems from difficulty with teaching patients virtually (20%), technology use (18%), establishing personal connections with patients (16%), and obtaining patient device data (11%). DCES indicated that larger treatment decisions like starting new therapies/devices occur less often over telemedicine whereas adjusting patient's settings occurs more often. For example, relative to in-person visits, 64% report starting patients on new insulin pumps less often while 62% report adjusting pump settings just as often. Conclusion: Telemedicine has become a regular part of DCES's practices despite notable gaps in satisfaction and ability to make certain treatment decisions when compared with in-person visits. Although telemedicine may be a useful tool for adjusting doses and device settings, these findings emphasize the need for improvements surrounding virtual diabetes care to alleviate the challenges experienced by providers.
ABSTRACT
Introduction: Pharmacogenomic testing can help guide treatment selection and dosing. The value of pre-emptive pharmacogenomic testing depends on the frequency of actionable variants and medication use patterns in the population of interest. Patients with high comorbidity burden are more likely to be hospitalized for COVID-19. These patients may benefit from pharmacogenomic testing for medications used to treat both their acute symptoms and chronic comorbidities. Further, institutional biorepositories for COVID-19 patients may provide an avenue for the return of pharmacogenomic results at minimal cost. Research Question or Hypothesis: What medications with pharmacogenomic guidance are used most often in patients hospitalized with COVID-19, and how often would pharmacogenomic results present opportunities to optimize care? Study Design: Cross-sectional analysis and simulation. Methods: We used a registry consisting of electronic health records from consecutive individuals hospitalized with confirmed COVID-19 at a large, urban academic health system. We characterized medication orders, focusing on medications with actionable pharmacogenomic guidance related to 14 commonly-assayed genes. A simulation analysis used medication order data and population phenotype frequencies to estimate how many treatment modifications would be enabled if multi-gene pharmacogenomic results were available. Results: Our cohort (n = 1852, mean age 60.1 years) was roughly an even mix of Black, White, and Hispanic individuals. During the index hospitalization, 19.7% required mechanical ventilation and 14.4% died. Sixty-four unique medications with pharmacogenomic guidance were ordered at least once in the cohort. Nearly nine in ten individuals (89.7%) had at least one order for a medication with pharmacogenomic guidance. The simulation estimated that 17 treatment modifications per 100 patients would be enabled if pharmacogenomic results were available. The genes CYP2D6 and CYP2C19 were responsible for the majority of treatment optimization opportunities, and the medications most often affected were ondansetron, oxycodone, and clopidogrel. Conclusion: Pharmacogenomic results would be relevant for nearly all individuals hospitalized with COVID-19 and would provide the opportunity to improve clinical care.