Diabetes Management in Rural Mississippi Before and During the COVID-19 Pandemic: A Program Evaluation

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Introduction: Management of type 2 diabetes mellitus (T2DM) in rural Mississippi was impacted by the onset of the COVID-19 pandemic resulting in an increase in telemedicine patient care visits. There is little evidence concerning the long-term quality outcomes of telehealth management of chronic diseases such as T2DM; thus, there is a need for examination of patient outcomes associated with telehealth provided care. Methods: To evaluate the efficacy of telehealth in T2DM management, a rural Mississippi clinic was home to a program evaluation to compare A1C measurements of patients with T2DM seen in face-to-face office visits during the year prior to the onset of COVID-19 to those seen during the pandemic which included a mixture of telehealth and face-to-face visits. Results: Pre COVID-19 data included 430 male and 531 female patients (face-to-face visits only). Post COVID-19 data included 507 male and 593 female patients (combination of face-to-face and telemedicine visits). Mean A1C levels were not statistically significantly different for patients between the two years compared; however, participants who received a combination of face-to-face and telehealth visits were more likely to have an uncontrolled A1C. There were no gender differences in A1C in the pre or post COVID 19 groups. In the post COVID-19 group, age was not significantly associated with A1C level (controlled vs. uncontrolled); however, in the pre COVID-19 group, age was significantly associated with A1C control (ages 18-45: 12.2% uncontrolled vs. ages 46-75: 6.4% uncontrolled). There was no significant change in follow up compliance. Discussion: Because few patients actually participated in telehealth visits, there are insufficient data to determine if telemedicine is an efficacious strategy to provide chronic diabetes management in this rural clinic. More data from telehealth visits are needed to determine telemedicine’s impact in rural outpatient diabetes management.

rural health, health promotion programs, diabetes management, COVID-19 pandemic, 2020-