IMPACT OF VIRTUAL DIABETES GROUP VISITS ON PATIENT OUTCOMES DURING THE COVID-19 PANDEMIC IN MIDWESTERN HEALTH CENTERS

ABSTRACT

BACKGROUND: Diabetes group visits (GVs) or shared medical appointments have been shown to improve clinical outcomes, but few have reported results from virtual diabetes GVs. No studies have evaluated virtual GVs among community health center patients across a region of the U.S. METHODS: Six health center sites across five states conducted six monthly virtual GVs with up to 12 adult patients with type 2 diabetes and suboptimal glycemic control (glycosylated hemoglobin (A1C) ≥8%). Virtual group visits consisted of six monthly 60 to 90 minute-long diabetes education sessions led by health center staff via a videoconferencing platform. GV patients enrolled at the site also had an appointment with their primary care physician within two weeks of each monthly virtual group visit. Primary outcome was change in patients' A1C from baseline to 6- months. Secondary outcomes were changes in patients' blood pressure, low density lipoproteins (LDL) and weight. Patients also completed surveys at baseline and 6-months describing their diabetes self-care behaviors and satisfaction with the virtual GVs. Generalized linear mixed models and linear mixed models were used to test the effects of GVs, time points and their interaction. RESULTS: Forty eight patients were enrolled (mean age 55 ± 12 years, 67% female, 63% black/African American, 32% white/Caucasian, and 8% Hispanic/Latino, 88% had public health insurance, mean baseline A1C of 9.84% ± 1.78%, 35% with A1c <9%). 34 patients completed one or more virtual GVs;14 patients attended no virtual group visits. At 6-months, average A1C was 8.96 ±1.82;A1C decreased by -0.56% ± 0.31 compared to baseline which was borderline significant (p=0.08). At 6-months, 58% of patients had an A1C < 9% which was borderline significantly decreased (p=0.055) compared to baseline. For patients with an A1C at baseline >9%, there was a significant decrease in A1C at 6 months (-1.06 ±0.45, p=0.03). There was no significant difference in blood pressure, LDL or weight from baseline to 6- months or association of number of visits attended and change in A1C. There were no significant changes in foot self-exams, blood sugar testing, nor exercise, but patients did report more days of healthy eating in the past week at 6-months compared to baseline (4.5 ±2.3 vs. 3.2 +2.7 days, p=0.02). Overall satisfaction with the virtual GVs was high with 90%of participants being very satisfied and 95% saying they would attend GVs in the future. CONCLUSIONS: Virtual GVs show high patient satisfaction and promise for improving A1C among patients with poor glycemic control who receive care in community health centers. Future studies are needed with a larger patient sample size and a control comparison group to determine which patients and health centers are best suited for virtual GVs.