Remote delivery of diabetes care within hospital: A natural experiment

Author(s): Nishchil Patel, Vaios Koutroukas, Carol George, Neil Marshall & Daniel Flanagan

Aim: This study aimed to assess if changes in the way healthcare was delivered during the recent COVID-19 pandemic resulted in a deterioration in the specialist support for people with diabetes in hospital. Was the provision of remote specialist inpatient diabetes care associated with measurable change in the quality of diabetes care provided in hospital?

Method: We compared outcomes of the PWCD group with the Patients With COVID-19 (PWC) group, without diabetes. We also compared the quality of care of a subset of PWCD with a matched group of people with diabetes but no COVID-19 infection (PWD).

Results: 74 of 411 people with COVID-19 admitted, had diabetes (PWCD). Mean length of stay was slightly longer for the PWCD group. The diabetes group were significantly older and had a significantly higher BMI.

Prescription errors were significantly higher in the PWCD group compared to PWD (29 vs. 14). Diabetes medication administration errors were also found to be higher in the PWCD group compared to PWD (84 vs. 20). Interestingly, number of good glucose days (4 to 12 mmol/L) was marginally better in the PWCD group (15) compared to PWD (13).

Conclusion: The novel finding of this study is that the quality of diabetes care was worse for the COVID and diabetes cohort. These data emphasise that direct contact between the specialist diabetes team, the PWD and the ward team remains very important in delivering good care. Consideration needs to be given to reducing risk if care is delivered remotely.