Evaluating virtual care for diabetes during the COVID-19 pandemic: results from a pre-post retrospective cohort pilot study in a Canadian family health team

OBJECTIVES: In this study we aimed to determine the feasibility of using electronic medical record (EMR) data to assess whether virtual care provided by a family health team (FHT) located in Ontario during the early COVID-19 pandemic impacted key diabetes indicators, and to identify whether content of diabetes-specific appointments was comparable to in-person care. METHODS: A retrospective pre-post cohort study was performed using patient-level EMR data from eligible FHT patients with type 2 diabetes. Feasibility outcomes were defined with prespecified success criteria. Scientific outcomes included 3 diabetes indicators: glycated hemoglobin (A1C), low-density lipoprotein (LDL), and blood pressure (BP). Indicator results from the prepandemic period (September 2019) and during-pandemic period (March 2020 to March 2021) were recorded and compared. Patient characteristics and content of diabetes-specific appointments were also collected. RESULTS: All feasibility outcomes met predefined criteria for success. No significant differences in A1C, LDL, or BP were identified between pre- and during-pandemic cohorts. Depression screening was performed significantly more frequently during the pandemic (73.85% vs 47.06%, p<0.001) at diabetes-specific appointments compared with the pre-pandemic period. No significant differences in frequency of screening for other complications (i.e. hypoglycemia, foot, eye) were found. CONCLUSIONS: Results signal that virtual care delivery in the during-pandemic period was not associated with significant changes in diabetes indicators or reduced screening for complications; however, many patients did not have BP measurements recorded during the pandemic. Findings support evidence that virtual care may help maintain continuity of care for diabetes management when in-person appointments may not be possible.