Current provision and HCP experiences of remote care delivery and diabetes technology training for people with type 1 diabetes in the UK during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has led to the rapid implementation of remote care delivery in type 1 diabetes. We studied current modes of care delivery, healthcare professional experiences and impact on insulin pump training in type 1 diabetes care in the United Kingdom (UK). METHODS: The UK Diabetes Technology Network designed a 48-question survey aimed at healthcare professionals providing care in type 1 diabetes. RESULTS: One hundred and forty-three healthcare professionals (48% diabetes physicians, 52% diabetes educators and 88% working in adult services) from approximately 75 UK centres (52% university hospitals, 46% general and community hospitals), responded to the survey. Telephone consultations were the main modality of care delivery. There was a higher reported time taken for video consultations versus telephone (p < 0.001). Common barriers to remote consultations were patient familiarity with technology (72%) and access to patient device data (67%). We assessed the impact on insulin pump training. A reduction in total new pump starts (73%) and renewals (61%) was highlighted. Common barriers included patient digital literacy (61%), limited healthcare professional experience (46%) and time required per patient (44%). When grouped according to size of insulin pump service, pump starts and renewals in larger services were less impacted by the pandemic compared to smaller services. CONCLUSION: This survey highlights UK healthcare professional experiences of remote care delivery. While supportive of virtual care models, a number of factors highlighted, especially patient digital literacy, need to be addressed to improve virtual care delivery and device training.

Current Provision and HCP Experiences of Remote Care Delivery and Diabetes Technology Training for People with Type 1 Diabetes in the UK during the COVID-19 Pandemic

The covid-19 pandemic has led to rapid implementation of remote care delivery in type 1 diabetes (T1D). An understanding of current modes of care delivery and HCP experiences is required to improve care. The UK Diabetes Technology Network undertook an online survey aimed at members providing care in T1D. One hundred and forty three HCPs (47.6% diabetes physicians, 51.8% diabetes educators) from 105 UK NHS centers (51.7% university hospitals, 45.8% general/community hospitals), responded. Median (IQR) percentage of consultations and time taken via face-to-face, telephone and video were 20%(5-30), 30 minutes (20-34);50% (30-80), 20 minutes (15-30) and 10% (0-35), 30 minutes (20-30), respectively. Sixty four percent responded that remote consultations offered an effective strategy for care delivery. Common barriers were patient familiarity with technology (72%) and access to patient device data (67.1%). Devices with smartphone based automated cloud uploads made consultations easier (73.4%), more effective (84.6%) and facilitated hospital discharges (60.9%). Median (IQR) responses on a 7-point scale for effectiveness of remote training, compared to face-to face, for new CSII starts, CSII renewals and CGM starts, were reported as 5 (4-6), 5.5 (5-6) and 6 (5-6), respectively. Common barriers included patient digital literacy (60.8%), limited HCP experience (46.2%) and time required per patient (43.6%). A reduction in new starts (72.8%) and renewals (60.9%) for CSII was highlighted by most. Variation was noted in proportion of new CSII starts being done virtually (53.9% respondents reporting <20% and 32.9% reporting >60%). Most (92.4%) responded that remote consultations and technology training are likely to continue post-Covid19. This survey highlights the impact of COVID-19 on access to diabetes technology and demonstrates how HCP's have embraced remote care delivery, but digital literacy remains a barrier.