Covid-19

Doctors Using Telehealth Services To Minimize Contact With COVID-19 Patients Who Have Diabetes

In-patient treatment of COVID-19 patients with preexisiting diabetes at the University of Northern Carolina (UNC) has moved to the virtual space during the pandemic. Doctors are shifting services online and now remotely provide healthcare to minimize exposure to the virus and to preserve personal protective equipment, which is in short supply. 

The study period that lasted for 15 weeks found that virtual diabetes management was as feasible a treatment option as traditional in-person consultation. Glycemic control was possible and comparable to conventional medical treatment for inpatient diabetes, they found. From March 22 onwards, face-to-face contact had been suspended with these patients.

As much as possible, telehealth services involve phone calls before 9 a.m. every day. In case the patient was not able to pick up, the primary nurse and family members were called instead. Morgan S. Jones, MD, Department of Medicine, University of North Carolina School of Medicine, led the research project titled "Inpatient Transition to Virtual Care During COVID-19 Pandemic". The co-authors were from Tufts University in Boston. 

A diabetes care team (DCT) was constituted by the University of North Carolina division of endocrinology in July 2019. The team now comprises of eight endocrinologists and two advanced practice providers. “Inpatient service teams for which the DCT was initially deployed were vascular surgery, cardiothoracic surgery, burn surgery, and the heart failure service,” the researchers explained about the project's first start.  

Iowa Board Of Medicine Seeking To Halt Abortion Telemedicine A representational image of telemedicine. CDC.gov

“Initially, we limited physical exams and shifted inpatient duties to providers younger than 65 years of age. We also limited potential provider exposures by rounding away from the patients' bedside,” the researchers added.  

Out of 40 patients under investigation for COVID-19, 10 people with diabetes tested positive. Of them, eight did not require insulin before in-patient hospital admission. On average, however, the total daily dose of insulin administered was at 73.5 units. Data collected from finger-stick blood glucose values (FSBG) showed inconsistency in insulin requirements.

“The smooth transition to virtual care may have long-term implications especially for remote area consults where endocrinologists may not be available. The real unknown is if the payors will continue similar reimbursements after COVID is gone,“ DTT Editor-in-Chief Satish Garg, MD, Professor of Medicine and Pediatrics at the University of Colorado Denver, said. 

“The FDA recently authorized use of continuous glucose monitoring (CGM) for the inpatient setting, and UNC authorized for hospital inpatient use of CGM only last week. I believe authors are in the process of implementing the use of CGM for inpatient diabetes management," Garg added further.

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