One of the biggest shifts in terms of diabetes care during the current pandemic has been movement from in-person clinic visits to virtual clinic visits. After a few months of navigating this new world, we checked in with the community to learn about their experiences having diabetes virtual visits. Read on for some of the highs and lows of virtual diabetes care as well as some tips to prepare for your upcoming visits.
If you’re living with diabetes, chances are you are very well versed with the healthcare system. You know where the best place to park near the hospital is and where you can grab coffee before heading in for the mandatory hang-out in the waiting room (because, let’s be honest, you never know how long you’ll be there!) You have probably experienced the fear of cancelling an appointment at the risk of not getting back in for another 6-8 months. As the pandemic has forced the healthcare system to rethink diabetes education delivery, it’s pushed many in the diabetes community into a whole new world! We reached out to members of the diabetes community who were navigating virtual appointments and have compiled our biggest learnings from those conversations.
Our biggest learnings:
- Technology can take a lot off of your plate.
- Virtual care favours those with access to technology.
- It’s easy to miss an appointment.
- Virtual diabetes appointments can remove barriers if appointments make you anxious.
- Preparing for your appointment can require more forward thinking.
Top recommendations to make your virtual appointment a success:
- Contact your clinic ahead of time via phone or email to find out which of your data they already have access to.
- Set a goal for your appointment and communicate this with your team.
- Test out the communication tech before your appointment time.
- Find out what data-sharing technology your diabetes devices have available to you.
- Get comfortable. Take advantage of not meeting in a sterile clinic room.
Technology helps bring care into real time.
Today’s technology helps to facilitate successful virtual visits. For many people, gone are the days of manually recording blood sugars in a log. Instead, many blood glucose (BG) meters, insulin pumps, smart pens, and continuous glucose or flash monitors track much of the data that is useful for our clinics in helping navigate diabetes challenges. Have you ever been asked what you had for dinner last Tuesday or questioned why your BG spiked at 1:15pm 3 weeks ago? Today’s diabetes technology make it easier to pull all of our data and information together into one place, so we don’t have to rely as heavily on our memory of events-of-the-past.
A few of our favourite diabetes data logging options include the following. Note that in most cases, clinics will be required to send you a ‘share code’ or set you up in their system the first time around:
Provide clinics with constant access – no need to upload:
Dexcom’s Clarity
Abbott’s Freestyle LibreLink
*must be using your phone to scan for automatic uploads
Requires manual upload of data, pre-visit:
Abbott’s Freestyle LibreLink
*if using the reader to scan, and not your phone
Diasend for Omnipod and Tandem’s t:slim
Medtronic’s CareLink
Upload requirements vary, but it is likely these reports are unfamiliar to your clinic and you may need to download them and forward via email (or whatever method of communication your clinic has set up) to your team:
Tidepool Reports
Nightscout Reports
We checked in with a few community members about the ways that diabetes tech impacted their virtual diabetes care appointments:
“I am currently looping, using a Paradigm Medtronic insulin pump and a Dexcom G6. Uploading my Dexcom G6 data to my clinic was quite easy. When I first started using Dexcom, my clinic provided me with a Sharing Code for my Clarity account. They now have real-time access to my Dexcom reports. I love that I can see the same reports that my clinic can see (and that once it was hooked up, it requires no extra time.) It makes me feel more prepared going into an appointment, knowing that we are both looking at the same thing at the same time. Also, I ALWAYS loose cords and cables, so not having to ‘plug in’ has been a game changer for me.”
~ Jen, Toronto
“I use Diasend for my Tandem Tslim pump. The download literally takes maybe 30 seconds via USB and then all the charts and graphs I can create and reports to save and send to my endo can be viewed there! I wish there was an option like Libre View [downloading software for FreeStyle Libre users] so they can just log in because I’m notorious at choosing the wrong graphs and dates (once looked at data that was two years old by mistake). Both devices are very easy to get access to the information and it’s super helpful that my clinic knows how to utilize this.”
~ Angelica, Toronto
Virtual care favours those with access to technology.
While virtual visits seem exciting and easy, it’s important to remember that they’re far simpler for those who can readily access technology. For many, the technology that enables virtual care to feel seamless isn’t available, isn’t accessible, or feels difficult to navigate compared to an in-person appointment. Barriers exist related to affordability of devices, wifi-access, and computer access. It’s important to ensure that those without readily accessible technology have options to successfully navigate a virtual appointment.
“Having shitty internet where I currently live does not allow me to transfer any data from any of my devices. So the alternative is phone appointments with the nurses. Which is difficult to say the least. I haven’t spoken to or seen my endo in almost a year.”
~ Pat, Dorset
It’s easy to miss an appointment.
While virtual appointments can provide increased convenience and ease of access for some, they can also be easy to forget about. We heard from several community members who either missed an appointment phone call, accidentally screened a call coming from an ‘Unknown Number’, or let time get away from them. We also heard that Virtual Appointments may feel easier and less burdensome to cancel at the last minute. For some, the structure and circumstance of an in-person appointment makes the entire process feel more significant. Something about virtual appointments that can make them easy to cancel, not book, or not attend, and many community members have expressed that they opted to not attend their virtual appointments.
Some tips we recommend include:
- Setting calendar reminders with notifications turned on so you don’t get sucked into email and miss a call. This is especially helpful for folks who are working remotely;
- Saving your clinic’s phone number in your phone, labelled. Although a lot of calls will still come from Unknown Numbers, there’s always a chance that the clinic has a listed number that could display on your phone;
- Tell someone else that you have a virtual appointment at a certain time. Sometimes verbalizing these things can make a big difference;
- Set a goal for your appointment the morning of, or the night before. This could give you something to look forward to achieving and help keep the appointment top of mind. Goals include: Working on increasing your Time in Range by 2% in the next month; Finding 2 resources for mental health support around burnout; Learning about a new feature on your device from your diabetes team;
“My diabetes clinic is in my hometown – about an hour and a half away from where I currently live. Between work and school, trying to factor in a three hour round trip in the car just became incredibly frustrating at times – especially if appointments are running behind! So when life gets really busy, I might feel tempted to cancel or reschedule an appointment. Being able to hop onto Zoom for half an hour was a lot easier to fit into my life, and made me more likely to follow through with the appointment.”
~ Kendra, Orangeville
Virtual diabetes appointments can remove barriers if appointments make you anxious.
It’s clear from our work in the community, that people have such a vast array of experiences when it comes to diabetes appointments and care. Some people look forward to meeting with their teams, catching up, and finding out what is new in the world of diabetes. For others, the thought of attending an appointment can be crippling. Sometimes, being with your diabetes healthcare team, no matter how well-intentioned, can be uncomfortable and stressful. For some, the hospital or clinical setting can make what should be a routine, potentially valuable, appointment an unpleasant experience. These feelings can also be intensified by personal circumstance, including our mental health.
Virtual diabetes appointments can remove many of these barriers by allowing you to attend your appointment from a space that is more comfortable and convenient for you. No more waiting rooms, check-in lines, parking fees, elevator waits… those hospital smells. Instead, you can grab your favourite tea, slip on your comfy sweater, and tune in from home!
“To be fully transparent, I was much happier to have the appointment virtually than to visit the hospital. My anxiety can be crippling at times and this was much easier for me mentally… because of my mental illnesses, I have faced massive barriers leaving the house; that is all exacerbated if I am attending a doctor’s appointment. I struggle with social anxiety so being around other people makes me very uncomfortable. Additionally, I am always afraid that I am ‘not doing good enough’ when it comes to managing my diabetes (even if all the reports say otherwise). Also, with an in person visit comes stepping on the scale. And I find that such a difficult, debilitating thing.”
~ Rebecca, London
Preparing for your appointment can require more forward-thinking
While we’ve touched on the time-saving benefits of virtual appointments, there still are things to prepare before your first appointment. In many cases, routine blood work still needs to be completed. With increased health and safety protocols in labs, this experience can be much longer than anticipated. One recommendation to help with this is to see if you have a LifeLabs location near you. LifeLabs not only allow you to book appointment slots ahead of time, eliminating wait times in the lab, but they also show current wait times online and provide you with access to all of your results in your online account.
One of the biggest things to be done to help make an appointment a success iis ensuring your clinic has sufficient access to your medical data – be it pump downloads, CGM downloads, or logbook data. Many pumps have online platforms which clinics can access when the user gives them permission (see above).
Additionally, CGM and Flash Technology tools from companies like Dexcom and Abbott have the option to share your data with healthcare providers. Even with this technology, however, for several of the systems, you’ll still need to remember to find your cord, plug your device in, and instigate an upload for your clinic. During in-person visits, most people found they did not need to think much about this ahead of time because all of the download resources and hardware was set up in their clinics for them.
For those recording data in a logbook, there are some more steps to consider. Some may opt to scan pages of their logbooks and email that to the clinic; others may drop logbooks off at the clinic in advance of their appointment. Once you have shared your data with your healthcare provider, always confirm that they have received it.
“While sharing my CGM data with the clinic was quick and easy, I had a harder time sharing my pump data through diasend. My clinic has some issues on their end connecting via diasend, and as a result they didn’t have my pump data at the start of our meeting. I forgot about this little quirk, and it did set us back a bit.”
~ Kendra, Orangeville
Diabetes appointments often have a feeling of routine to them. You go through a lot of the same motions during them – height check, weight check, blood pressure, discussing current regimens and more. The seemingly informal nature of a virtual appointment can make it easy to move through the motions rather quickly, losing an opportunity to go over questions, concerns or inquiries you may have about your current management regime. As such, taking the time to set goals for your appointment, and vocalizing those goals ahead of time, can help ensure efficiency and satisfaction.
We foresee in the future virtual care visits becoming more of the norm. As we get settled into our new normal of diabetes care, there will certainly be some steep learning curves for everyone involved. At CIM, we look forward to working with our community as we navigate these changes, learn & grow together!
The switch to virtual doctor appointments has been one of many changes in our lives resulting from the COVID-19 pandemic. Read more about the experiences of people living with type 1 diabetes in the pandemic, here.
