1446-P: Success of a Hybrid Care Model to Maintain Glycemic Control in Older Adults with Type 1 Diabetes (T1D)

Abstract

Aim: During the COVID-19 pandemic, a hybrid care (in-office and telemedicine) model was urgently implemented. Impact of this hybrid model on clinical visit frequency and glycemic outcomes in older adults with T1D warrants study. Methods: Demographics, clinical characteristics, and clinical visits of older adults (aged ≥65 years) with T1D were retrieved from electronic medical records covering 2 time periods, before the pandemic (pre-pandemic: April 1, 2019-March 1, 2020) and during the pandemic (pandemic: September 1, 2020 to August 31, 2021) periods, with adjustment for length of follow-up. Results: 661 (45% male) unique older adults with T1D received care and had HbA1c measurements in both periods at a tertiary diabetes center. Mean age was 72±5 years; 59% were CGM users, 38% were pump users. Clinic visits in the pre-pandemic period were almost all in-person, averaging 4.2 visits/person/year (CI 3.9-4.4), with <2% as phone visits. During the pandemic period, the mean number of visits was significantly greater than in the pre-pandemic period, at 6.3 visits/person/year (CI 5.7-6.9), with 30% in-office, 38% by video, and 32% by phone. HbA1c values were similar between periods (pre-pandemic: 7.6% (CI 7.5-7.8) vs pandemic: 7.4% (CI 7.3-7.6)). However, there was a significant, favorable shift in HbA1c distribution <7%, 7-8%, >8% when using hybrid care model: pre-pandemic period 21, 42, 37%, respectively; pandemic period 35, 36, 29%, respectively (pre-pandemic vs pandemic period p<.0.001). Conclusion: Compared with the pre-pandemic care model, the hybrid care model during pandemic for older adults with T1D allowed for increased visit frequency and preserved HbA1c values while favorably increasing the proportion with HbA1c <7% and decreasing proportion at the higher end of the distribution. This data support ongoing use of a hybrid care model for older adults with T1D. Disclosure A.Adam: None. M.Munshi: Consultant; Sanofi. R.Hurlbert: None. C.Slyne: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. E.Toschi: Advisory Panel; Eli Lilly and Company. Funding Thomas J. Beatson, Jr. Foundation