Virtual Diabetes Care during COVID-19: Practical Tips for the Diabetes Clinician

Now, more than ever, is the time for diabetes providers to fully embrace telehealth. Because of the importance of glycemic data in diabetes care, the field of endocrinology is already enabled with a number of tools that allow continuous real-time access to patient generated health data. We are uniquely poised to use diabetes technology for what it is supposed to allow: remote, fully connected diabetes care.

For years, academic medical centers have been flirting with a full embrace of telehealth, but with the current COVID-19 pandemic, we must now rise to the challenge. At our institution, we have been using telehealth in both general endocrinology and diabetes care for the past few years, with a focus on providing care to patients at a significant geographic distance from our center. Now as we promote social distancing to preserve the health of outpatients, the role for telemedicine is even more acute. We can and should be practicing in a digital first, virtual model of diabetes care*.

A recently published article guides readers on the “Top 10 Tips for Successfully Implementing a Diabetes Telehealth Program.”** Here we briefly describe the most important steps we have taken at our own institution, UCSF, to allow optimal diabetes care alongside the rapid increase in our volume of telehealth visits. Within the past week at UCSF, video visits have risen from around 2% of all ambulatory visits to nearly 50% of all visits on a daily basis.

1. Encourage patients to start sharing their diabetes data with the clinic. For patients using glucometers: encourage them to start using Tidepool. Patients can upload data from their glucometers at home using the Tidepool Uploader. With an invitation from the clinic, patients share their data with providers. Most glucometers are supported, which eliminates the need to use multiple different software platforms.
   
   
   
   For patients using continuous glucose monitors and/or insulin pumps: encourage them to start sharing data on Tidepool, or alternatively on device-specific software platforms (e.g. Dexcom Clarity, Medtronic Carelink, Abbott LibreView).

2. Discuss and interpret diabetes data with the patient. Now that patients are connected to continuous data sharing, CGM data can be viewed remotely during a scheduled video visit. Use screen sharing so patient and provider are reviewing the same information – make it a teachable moment!

3. Interpret diabetes data outside of scheduled video visits. If patients contact the clinic with diabetes management questions, providers or their team members can review relevant glucose data online and provide guidance.

4. Seek reimbursement for data interpretation. Interpretation of 72 hours of CGM data can be billed using CPT code 95251; remote monitoring of glucose data from fingersticks is also billable with CPT codes 99091 or 99457.

5. Capture patients’ use of diabetes devices at a clinic level. Who uses a continuous glucose monitor? Who uses an insulin pump? What brand? This device-specific information enables a clinic to do proactive patient outreach. Targeted patient communication may become increasingly important to convey clinical messages during the pandemic.

What does this mean for the future?

In the short term, a shift to telehealth means that we can still provide good care for our patients with diabetes, while keeping those who are most vulnerable safe at home. We can access and discuss the data that is so foundational to diabetes care.

Of course, there are still patients for whom in-person care is preferred, in spite of the risks – perhaps to discuss a new diagnosis face to face, to conduct a critical physical exam, to train a patient and caregiver on how to use an injectable medication. But given that we are equipped with the digital tools to make a virtual visit effective for many patients, the onus is on us as clinicians to at least consider the virtual care option first. Our ability to rapidly scale up and adapt our use of virtual diabetes counseling will be critical to providing ongoing care for our patients remotely.

By Tejaswi Kompala, MD, UCSF Clinical Fellow

* Duffy S, Lee TH. In-Person Health Care as Option B. N Engl J Med. 2018;378(2):104-106. doi:10.1056/NEJMp1710735

** Crossen S, Raymond J, Neinstein AB. Top Ten Tips for Successfully Implementing a Diabetes Telehealth Program. Diabetes Technol Ther. March 2020. doi:10.1089/dia.2020.0042