Abstract: Disengagement from advanced diabetes technologies during the COVID-19 pandemic associates with worse short-term outcomes in the US T1D exchange quality improvement collaborative
C. Vandervelden1, M. Barnes1, E. DeWit1, D. Williams1, R. McDonough1, N. Noor2, R. Izquierdo3, M. Greenfield4, C. Demeterco Berggren5, A. Roberts6, H. Hardison2, O. Ebekozien2, M. Clements1
11 Children's Mercy, Kansas City, United States, 2T1D Exchange, Boston, United States, 3Upstate University Medical Center Pediatrics, Syracuse, United States, 4Upstate University Medical Center Adult, Syracuse, United States, 5University of California, Rady Children's Hospital, San Diego, United States, 6University of Washington, Seattle Children's Hospital, Seattle, United States
Introduction: The use of Advanced Diabetes Technologies (ADT) such as continuous glucose monitors, insulin pumps, and hybrid closed-loops systems, is associated with improved outcomes in type 1 diabetes care.
Objectives: To determine short-term glycemic outcomes occurring after device disengagement during the COVID-19 pandemic.
Methods: We conducted a retrospective cohort study on individuals from 15 diabetes centers, from 2020-04-01 through 2021-12-31 who were initially using a diabetes device (N = 7599). We examined Diabetic Ketoacidosis (DKA) incidence and A1c for individuals who disengaged from diabetes devices (defined as discontinuing device usage in the following two encounters) to those who remained engaged, stratified by encounter type (in-person vs. telehealth).
Results: For in-person and telehealth encounters, individuals who disengaged from diabetes devices experienced more DKA events and had higher A1c values compared to those who remained engaged with devices. For in-person encounters (N = 4182), DKA incidence increased from 7.6% to 11.1% (p < 0.001) and the median A1c increased from 8.1% to 8.2% (p = 0.005) with device disengagement. For telehealth encounters (N = 3417), DKA incidence increased from 11.4% to 13.9% (p < 0.001) and the median A1c increased from 7.9% to 8.3% (p < 0.001).
Conclusions: Disengagement from Advanced Diabetes Technologies is associated with worse short-term glycemic outcomes regardless of encounter type. Those attending in-person encounters appeared to experience less rise in A1c than those attending telehealth encounters. Future studies examining factors associated with disengagement among those attending in-person versus telehealth visits may offer new insights into strategies to prevent disengagement.
