Diabetes Self-Management in a COVID-19 World

June 1, 2020
Leslie Kolb, RN, BSN, MBA
Leslie Kolb, RN, BSN, MBA
Leslie Kolb, RN, BSN, MBA

The COVID-19 pandemic has altered our world in many ways, not all of them negatively. One of the most beneficial changes involves the expansion of care via telehealth. This increased access is proving especially valuable for people with diabetes, whose challenges in managing their disease have been exacerbated during these stressful times.  

For several years the healthcare industry has been trying to determine how best to provide telehealth while ensuring reimbursement. The COVID-19 pandemic has forced the issue and the CMS has made several revisions to pay structure and access that open the doors for more people to receive this kind of care, changes that also are being honored by most private payers.

This increased access to telehealth has been especially helpful for people with diabetes who are receiving diabetes self-management education and support (DSMES). Research has shown this care helps people with all types of diabetes better self-manage their blood glucose, improve mental and emotional well-being, reduce the risks for complications and decrease costs by reducing or eliminating the need for medications and emergency room visits. It also connects individuals with cost-saving programs.

Diabetes self-management education and support from the comfort of home
DSMES typically is provided by a nurse, dietitian, pharmacist or other specialist in diabetes care and education in hospitals, pharmacies, provider’s offices and other health facilities. COVID-19 brought the in-person form of this care to a halt, but telehealth expansion means it is now an option.

Prior to the pandemic, CMS mostly reimbursed for in-person DSMES (which CMS calls diabetes self-management training, or DSMT) and mandated it be conducted in the group setting in most cases. One-to-one DSMES was allowed if there were barriers to learning (such as the person was blind or hearing-impaired). CMS has now relaxed the requirements so people with diabetes can receive one-to-one care at home via video. If video is not available, DSMES can be provided by phone. DSMES is one of the few health services CMS has deemed can occur by phone. 

This expansion in care has resulted in some amazing success stories that illustrate the unique benefits of telehealth. When in their own home environment, people with diabetes can readily share with their diabetes care and education specialist what they are doing to manage their care. For example, when connecting by video, they can share visuals of their foods and nutrition labels or monitoring devices.

Removing barriers to care
Telehealth has been particularly helpful for people in rural areas, who typically travel a long way to receive care. Eliminating this barrier means fewer missed appointments and better diabetes self-management. Diabetes care and education specialists are finding it easier to reach people on a regular basis to really focus on making small changes, leading to improved outcomes due to the continuity of visits.

The hope is that CMS recognizes the huge opportunities telehealth provides to people with diabetes and further expands access. This would include waiving the requirement that the initial 10 hours of DSMES must be provided in a 12-month period, and allowing any healthcare provider who sees a person with diabetes – whether emergency room physician or orthopedic specialist – to prescribe DSMES, not just the treating providers as currently required.

Other notable changes include pharmaceutical companies lowering the cost of insulin during the pandemic and the Food and Drug Administration allowing the use of continuous glucose monitors (CGM) in people with diabetes who are on insulin if they are hospitalized during the pandemic. This is particularly helpful if they are hospitalized for COVID-19 because people with diabetes are at very high risk for complications if they do become infected. The consistent monitoring provided via CGM ensures their insulin levels remain steady, freeing up providers to address other often complex health issues. 

The hope is that all of these changes remain permanent after the pandemic wanes, especially access via telehealth, which could be a huge boon for people with diabetes by expanding their options for receiving DSMES. Among people with diabetes, only 6.8% with private insurance and 5% of Medicare beneficiaries participate in diabetes education in the first year of diagnosis, according to the CDC.

While a return to in-person care typically is preferred for all types of healthcare, telehealth clearly expands access and provides opportunity to ensure more people get the care they need.

Leslie Kolb is chief science and practice officer at the Association of Diabetes Care & Education Specialists, headquartered in Chicago.