Remote consultations have greatly facilitated the delivery of healthcare in the United Kingdom (UK) over the last 24 months. During the first lockdown in response to the COVID-19 pandemic in March 2020, healthcare professionals (HCPs) were forced to conduct most outpatient clinical activity by telephone or video. In the Type 1 Diabetes Exchange Quality Improvement collaborative, telemedicine visits increased from <1% pre-pandemic to 95% in April 2020, representing a near total digitalisation of type 1 diabetes care delivery amongst clinics in this network, during this time.1 More recently, while many other aspects of care have gradually returned to normal, there is a debate about the best way in which to continue to use remote consultations to complement traditional face-to-face visits into the future. Remote consultations (also called virtual or telemedicine consultations) is an umbrella term that encapsulates both video and telephone consultations. Diabetes lends itself well to remote healthcare provision, as cloud-connected technologies including continuous glucose monitoring devices facilitate data sharing between the person with diabetes and their clinical team. Although not suitable for everyone, remote consultations have the potential to improve access to, and the efficiency of, our outpatient clinics as they tend to be shorter than face-to-face reviews.2, 3 Indeed, a previous meta-analysis confirmed that telemedicine interventions in diabetes were associated with greater reductions in glycated haemoglobins (HbA1c) compared to usual care.4 In the UK, the majority of remote diabetes consultations are conducted over the telephone, with some conducted using video.3 Video consultations offer some advantages over telephone, including a more personal interaction with enhanced audio/visual cues and data sharing capabilities with opportunities for education. However, their technical requirements are more complicated and time requirements are usually longer.3 Though studies are small, the evidence suggests that video consultations in both primary and secondary care are safe and effective.5 Data from a diabetes service in Newham (UK), which replaced selected outpatient appointments with webcam consultations found a trend towards improved glycaemic control in the group using the webcam service, high levels of patient satisfaction with video-mediated consultations and modest cost savings for the health service.6 Telephone consultations are limited by lack of visual cues and are typically more suited to dealing with a limited range of specific concerns. Historically, within diabetes, telephone contacts have been utilised as an adjunct to a face-to-face outpatient clinic appointment to monitor adherence to treatments, to assess the effectiveness of a therapy change or to optimise medication regimes. Traditional diabetes consultations include a measurement of blood pressure and weight, a foot examination and an inspection of injection sites. People with diabetes should be supported to undertake blood pressure and weight measurements at home where possible, though many may not have the required equipment. Whilst a limited physical exam can be conducted via video consultation, and may be useful to monitor progress of an active diabetic foot ulcer, assessing for early signs of peripheral neuropathy and identifying subtle areas of lipohypertrophy is not possible and this has the potential to lead to patient harm. Video consultations can be significantly hampered by technical challenges that can disrupt the flow of conversation.2, 7 These can affect the HCP and/or the patient and may relate to the hardware available for video consultations, the internet connection, the interoperability of healthcare approved video consultation systems with other operating systems/devices or the availability of an appropriate location/setting to conduct the consultation.5 Shaw et al., evaluated video consultations in different clinical settings (including diabetes and antenatal diabetes) across 2 NHS trusts in the UK.7 Opening the video consultation, dealing with audio/visual issues and conducting a physical exam were the main challenges identified for video mediated interactions.7 The widespread adoption of video consultations in clinical practice will depend on investment in, and development of, local IT resources, as well as the provision of training to HCPs and patients alike, to optimise video-based interactions. It will also require more appropriate time allocation and scheduling since patients may need to be ready on a video portal for their consultation, rather than be called during a flexible time window. Training HCPs for remote consultations should include ensuring the patient has the right equipment and confirming their identity. Measures should also be taken to ensure any required information, such as connected glucose devices and insulin pens/pumps are available. Often, HCP's will need to be able to view hospital electronic health records, glucose and insulin data, as well as see the patient on a video screen, and so to work smoothly, HCPs need access to multi-screen environments where their conversation can be confidential. When considering the implementation of remote consultations, it is imperative that health services ensure that marginalised groups are not excluded. The digital divide disproportionately disadvantages older people and those living in poverty.8 In primary care, remote consultations are more likely to be utilised by younger working people, non-immigrants and women, and internet-based consultations by younger, more affluent and educated groups.9 Almost 12 million people in the UK lack sufficient digital skills for everyday life.10 This increases the risk of social isolation and health inequalities in a vulnerable cohort, particularly in the context of the pandemic. Additional training and support should be provided to people with language and cultural barriers and those with low levels of digital literacy, to increase the chances of successful remote consultations. It is possible that remote consultations could widen disparities in care for people with sensory and communication disabilities, and those with impaired cognition who may be unable to access relevant telephone or video technologies. Hence, those who struggle to adapt to digital healthcare should be identified early and offered face-to-face appointments. A flow chart for the process of undertaking a remote consultation is outlined in Figure 1. Although experience suggests high levels of satisfaction with video consultations, face-to-face consultations are still seen by many, as the ‘gold-standard’.11 Whilst remote consultations may improve access to healthcare and convenience for patients, they tend to be less information rich compared to face-to-face contacts. Remote consultations offer a more transactional style of medicine and in the absence of non-verbal cues, HCPs may find it difficult to identify diabetes distress or other psychological issues which may be affecting their diabetes self-management.12 If patients perceive their queries/concern are being inadequately addressed, this can impede service efficiency by creating additional work for HCPs later on. It is important to set expectations for patients regarding the frequency and content of their remote care. Interestingly, a recent survey of people with diabetes reported a significant decline in the number of people willing to continue with remote appointments beyond the pandemic.13 This highlights the need for both an individualized and a hybrid approach to diabetes care whereby remote consultations can serve as a supplementary review when a face-to-face appointment is not required, or as an alternative modality of care, when in-person reviews are not possible. Future research should focus on exploring the safety, cost and sustainability of remote consultations amongst vulnerable service users. Moreover, patients' and HCPs' experiences of the barriers to remote consultations should be addressed to design an improved telemedicine service.3 The key factors that determine a patients' suitability for a remote consultation include their underlying condition, digital literacy, device requirements and their personal preference. Ensuring the adaptability of the service to this variation in patients' needs is crucial to the successful implementation of a hybrid model of digital and in-person care. HF reports personal fees and/or education grands from Dexcom and Sanofi Aventis outside of this submitted work. PC reports personal fees from Abbott Diabetes Care, Medtronic, Dexcom, Insulet, Roche, Novo Nordisk, Sanofi Avenis, Lilly Diabetes and Novartis, outside of this submitted work. PH has received personal fees from Abbott Diabetes Care, Dexcom, Eli Lilly, Insulet, Medtronic, Novo Nordisk, Sanofi Aventis and Glooko/Diasend outside of this submitted work. SH has nothing to declare. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.