Use of telemedicine in the care of pediatric patients with type 1 diabetes during COVID-19 pandemic in a Public University Hospital in Brazil

ABSTRACT

Introduction: In March 2020 diabetes outpatient clinics were closed and consultations suspended due to the restrictions imposed by authorities in the context of the COVID-19 pandemic. Telemedicine in Brazil was then urgently officialized. Considering that the majority of our patients come from a low socioeconomic background, the only alternative of communication was through a free mobile app via cell phone. Objectives: The aim of this study was to evaluate patient satisfaction and the effectiveness of care delivered by teleconsultations via cell phone in this population. Methods: This was a questionnaire-based cross-sectional study, completed using Google forms, offered to every patient/carer from the Pediatric Diabetes Outpatient Clinic of Santa Casa de São Paulo who received telemedicine care during this period. Complementary data were obtained from patients' electronic medical records. Results: In 12 weeks (between March and June 2020), from a total of 154 appointments, 83%(n=88) of patients were attended via asynchronous teleconsultations using a mobile app, 16%(n=17) were in-person and 31.2%(n=48) did not attend the consultation. The great majority of patients had their insulin dose adjusted (87.6%;n=85). From those who answered the questionnaire (87%;n=77), 93%(n=72) approved the telemedicine consultation and 59% said that glycemic control improved afterward. There were also economic benefits and less waste of time reported. Only 3 patients declared that they did not feel safe without face-to-face care. 60% declared they would like to continue alternating presential with online consultations after the end of the pandemic. Conclusions: During COVID-19 pandemics, the transition to telemedicine was associated with patients' satisfaction and efficacy in treatment adjustments. Considering the socioeconomic characteristics of this population, telemedicine via mobile app was a good option for offering diabetes care during a period of isolation.