Abstract
The aims of this study were to explore providers' perceptions of how COVID-19 affected patients' psychological wellbeing and diabetes self-care and discover how providers responded to sustain and improve patients' psychological health and diabetes management during the pandemic. Twenty-four semi-structured interviews were completed with primary care providers (n=14) and endocrine specialty clinicians (n=10) across sixteen clinics in North Carolina. Interview topics included: (1) current glucose monitoring approaches and diabetes management strategies for people with diabetes (2) barriers and unintended consequences encountered with respect to diabetes self-management, and (3) innovative strategies developed to overcome barriers. Interview transcripts were coded using qualitative analysis software and analyzed to identify cross-cutting themes and differences between participants. Primary care providers and endocrine specialty clinicians reported that people with diabetes experienced increased mental health symptoms, increased financial challenges and positive and negative changes in self-care routines due to COVID-19. To offer support, primary care providers and endocrine specialty providers focused discussions on lifestyle management and utilized telemedicine to connect with patients. Additionally, endocrine specialty clinicians helped patients access financial assistance programs. Findings indicate that people with diabetes experienced unique challenges to self-management during the pandemic and providers responded with targeted support strategies. Future research should explore the effectiveness of these provider interventions as the pandemic continues to evolve.
Highlights
COVID-19 restrictions challenged patient-centered care for diabetes
This study was conducted in the context of a larger study, Re-Think the Strip (RTS), which aims to promote the de‐adoption of daily self‐monitoring of blood glucose (SMBG) among non‐insulin treated patients with controlled type 2 diabetes given the lower utility of this practice [15–18]
Primary care and endocrine providers reported patients had increased mental health symptoms, mainly depression, anxiety, and general stress. These symptoms presented challenges to diabetes self-management. Depression Both primary care providers and endocrine specialty clinicians noticed that more patients were struggling with depression compared with time prior to the pandemic
Summary
Many ambulatory practices halted their in-person visits in favor of virtual appointments [1–3]. This posed a problem for the management of diabetes, which typically requires routine in-office monitoring, lab testing, and medication management. There was concern among the diabetes healthcare community that the pandemic would result in poor diabetes outcomes, as interruptions in appointments and HbA1c testing have previously been associated with worsened glycemic control [5, 6]. People with diabetes have struggled with selfmanagement practices in the face of COVID-19. Members of the diabetes community report concerns over finances and employment, which may have impacted insurance status and access to care [8]. A similar proportion of people had issues obtaining test strips, and 25% had difficulties obtaining pumps or continuous glucose monitoring supplies [10]
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