Rapid Implementation of a Diabetes Telemedicine Clinic During the Coronavirus Disease 2019 Outbreak: Our Protocol, Experience, and Satisfaction Reports in Saudi Arabia

Abstract

Background: The importance of telemedicine in diabetes care became more evident during the coronavirus disease 2019 (COVID-19) pandemic as many people with diabetes, especially those in areas without well-established telemedicine, lost access to their health care providers (HCPs) during this pandemic.

Subjects and methods: We describe a simplified protocol of a Diabetes Telemedicine Clinic that utilizes technological tools readily available to most people with diabetes and clinics around the world. We report the satisfaction of 145 patients and 14 HCPs who participated in the virtual clinic and 210 patients who attended the virtual educational sessions about "Diabetes and Ramadan."

Results: The majority of patients agreed or strongly agreed that the use of telemedicine was essential in maintaining a good glucose control during the pandemic (97%) and they would use the clinic again in the future (86%). A similar high satisfaction was reported by patients who attended the "Diabetes and Ramadan" virtual educational session and 88% of them recommended continuing this activity as a virtual session every year. Majority of the HCPs (93%) thought the clinic protocol was simple and did not require a dedicated orientation session prior to implementing.

Conclusions: The simplicity of our Diabetes Telemedicine Clinic protocol and the high satisfaction reported by patients and HCPs make it a suitable model to be adopted by clinics, especially during pandemics or disasters in resource-limited settings. This clinic model can be quickly implemented and does not require technological tools other than those widely available to most people with diabetes, nowadays. We were able to successfully reduce the number of patients, HCPs, and staff physically present in the clinics during the COVID-19 pandemic without negatively impacting the patients' nor the HCPs' satisfaction with the visits.

Keywords: COVID-19; Saudi Arabia; diabetes; telemedicine.

Figure 1.

A flowchart highlighting the protocol of the Diabetes Telemedicine Clinic. (a) Patient triage and scheduling the clinic visit. (b) Setting up the virtual clinic visit. (c) Conducting the virtual visit. (d) Ordering and delivering the diabetes medication and supplies.

Figure 2.

The proportion of online requests submitted by the patients from March 24 to April 24, 2020. Most frequent online request submitted by patients was “review glucose readings and adjust medications” (31%), followed by “refilling the diabetes supply” (28%); “others” which included questions about carbohydrate counting, device malfunction, and questions about diet (20%); “refilling diabetes medications” (8%); “question to the HCP” (7%); and “reschedule an appointment” (6%). Abbreviation: HCP, health care provider.

Figure 3.

Patients’ satisfaction with the Diabetes Telemedicine Clinic. (a) Level of patients’ agreements with the following statements: “Use of telemedicine was essential in maintaining a good glucose control during the COVID-19: outbreak,” “I spent sufficient time with the HCP during the virtual visit,” “I recommend making Diabetes Telemedicine Clinic an available option for patients with diabetes after the COVID-19 outbreak is over,” and “I will use the Diabetes Telemedicine Clinic again if this remains as an option for me after the COVID-19 outbreak is over.” (b) Patients rating of the quality of the following services: “Quality of the medical care provided during the virtual visit,” “Quality of the audio during the virtual visit,” “Clarity of the management plan discussed with the HCP during the virtual visit,” and “Ease of scheduling an appointment in the Diabetes Telemedicine.” Abbreviations: COVID-19, coronavirus disease 2019; HCP, health care provider.