Four Years of Pandemic Diabetes Care Reveal a Lasting Shift Toward Virtual Medicine

When the COVID-19 pandemic swept through health systems in early 2020, few areas of medicine were disrupted as visibly as the routine management of chronic disease. Diabetes care, which depends on regular laboratory monitoring, in-person examinations, and steady contact with primary care clinicians, seemed uniquely vulnerable. Yet a new four-year longitudinal study suggests that the story of diabetes care during the pandemic is not simply one of collapse and catch-up, but of a durable transformation in how care was delivered, with telemedicine and intensified drug therapy stepping in to fill the gaps left by cancelled screenings and deferred visits.

The research, published as an open-access article in BMC Endocrine Disorders, was led by Heng Yeh of Bassett Medical Center in Cooperstown, New York, together with colleagues from institutions including Memorial Healthcare System in Florida and Mount Sinai Health System in New York. The team set out to answer a question that earlier, shorter studies had left unresolved: what happened to diabetes care delivery not just in the first chaotic months of the pandemic, but across the full arc of the crisis? While early reports documented short-term drops in access to care and laboratory monitoring, the long-term evolution of utilization, telemedicine adoption, preventive screening, prescribing, and metabolic outcomes had remained poorly understood.

To capture that evolution, the investigators conducted a retrospective cohort study of adults with diabetes or prediabetes receiving care at a single health system between March 2018 and February 2022. That four-year window deliberately straddles the pandemic, allowing the researchers to compare patterns of care before and after COVID-19 reshaped clinical practice. The outcomes they tracked were broad and clinically meaningful: engagement with primary care, use of telemedicine, adherence to ophthalmology and podiatry screening, medication prescribing patterns, glycated hemoglobin (HbA1c), body mass index (BMI), urinary albumin-to-creatinine ratio (uACR), and mortality. A subgroup of patients who tested positive for COVID-19 was analyzed separately, and a sensitivity analysis restricted the cohort to patients with confirmed diabetes mellitus only, defined as HbA1c of 6.5 percent or higher, comprising 2,729 patients.

The cohort included 2,804 patients, and its demographic composition is notable in itself: 40.6 percent were Black, 28.0 percent Hispanic, 19.3 percent White, and 12.1 percent belonged to other groups. This diversity matters because diabetes disproportionately affects minority communities in the United States, and pandemic-era disruptions were widely feared to widen existing health inequities. The single-system design also gave the researchers an unusually consistent view of care delivery, since laboratory values, visit records, and prescriptions were all drawn from the same electronic medical record infrastructure, reducing the kind of fragmentation that can confound multi-site comparisons.

The headline findings are striking in their asymmetry. Primary care visits and telemedicine visits both increased significantly during the pandemic, while specialist screening for retinopathy and foot care declined substantially. In other words, the core relationship between patient and primary care clinician did not weaken; it adapted, migrating in part to virtual platforms. Meanwhile, the preventive examinations that require physical presence and specialized equipment, such as dilated eye examinations to detect diabetic retinopathy and foot assessments to catch ulcers before they become limb-threatening, fell behind. These screening gaps persisted even as other dimensions of care recovered or expanded, a pattern the authors describe as one of the defining features of pandemic-era diabetes management.

Perhaps the most reassuring result concerns glycemic control. Despite the upheaval, mean HbA1c remained essentially stable across the study period, at 6.9 percent before the pandemic compared with 7.0 percent during it, a difference that was not statistically significant (p = 0.343). For a chronic disease in which even modest deterioration in glycemic control can compound over years into retinopathy, nephropathy, and cardiovascular complications, the preservation of glycemic outcomes through a global health crisis is a remarkable result. It suggests that the disruptions, however real, did not translate into measurable metabolic harm for this cohort during the study window.

The researchers also observed a significant intensification of pharmacologic treatment during the pandemic. Prescribing of SGLT2 inhibitors, GLP-1 receptor agonists, and insulin regimens all increased. This therapeutic shift is consistent with broader trends in diabetes medicine, in which newer agents with proven cardiovascular and renal benefits have progressively displaced older treatment paradigms. But the timing is telling: clinicians leaned harder on medication adjustment precisely when in-person assessment was curtailed. The authors interpret this as evidence that virtual care and therapeutic adjustment compensated for service disruptions, allowing metabolic stability to be maintained even as the traditional machinery of chronic disease management, the quarterly office visit and the routine physical examination, was partially offline.

The COVID-19-positive subgroup offers a further window into how infection itself reshaped care. Among the 180 patients who tested positive for the virus, healthcare utilization doubled, reflecting the additional clinical attention that acute infection demands. Yet even in this group, the researchers observed no significant deterioration in HbA1c, BMI, or uACR. Given that diabetes is a well-established risk factor for severe COVID-19, and that acute illness can destabilize glycemic control, the absence of measurable metabolic deterioration in this subgroup adds weight to the conclusion that the care system, in its adapted form, remained resilient under stress. A sensitivity analysis restricted to patients with confirmed diabetes mellitus yielded findings consistent with the main cohort, strengthening the robustness of the results.

The implications of the study extend well beyond the pandemic that prompted it. The authors argue that diabetes care underwent a sustained transformation, not a temporary detour, and that post-pandemic care models should therefore integrate permanent telemedicine infrastructure, address the persistent gaps in preventive screening, and develop hybrid systems capable of maintaining continuity during future public health crises. The hybrid model they envision would combine the accessibility and convenience of virtual visits with deliberate strategies to ensure that eye examinations, foot assessments, and other in-person preventive services do not fall through the cracks. From a policy standpoint, the authors emphasize that preserving telemedicine reimbursement parity will be essential to sustaining these advances in hybrid care; without financial parity between virtual and in-person encounters, the gains of the pandemic era could erode as emergency flexibilities expire.

The study also carries a note of methodological caution and transparency. It was approved by the Memorial Healthcare Institutional Review Board under protocol MHS.2022.017, with informed consent exempted due to its retrospective design, and it received no external funding. The authors declare no competing interests. As a single-system retrospective cohort, the work cannot by itself establish causality or generalize to every population, and the preprint version of the article remains subject to further editorial refinement before the final version of record replaces it. Still, the four-year perspective it offers is rare and valuable. Most pandemic-era studies captured snapshots of weeks or months; this one traces the full trajectory, showing that the reorganization of diabetes care was not a blip but a durable shift. For the hundreds of millions of people worldwide living with diabetes and prediabetes, the lesson is that the infrastructure of chronic disease management can bend under extraordinary pressure without breaking, provided that virtual care, medication intensification, and renewed attention to preventive screening are woven together into a system designed for both everyday care and the next crisis.

Subject of Research: Longitudinal changes in diabetes care delivery, telemedicine adoption, and metabolic outcomes during the COVID-19 pandemic

Article Title: Longitudinal shifts in diabetes care delivery during the COVID-19 pandemic: implications for post-pandemic models of chronic disease management

Article References: Yeh, H., Acevedo Martinez, E., Harrisingh, K., Nguyen, Q., Sigdel, S., Goldberg, J., Sikha, A., Chang, C., & Niu, J. (2026). Longitudinal shifts in diabetes care delivery during the COVID-19 pandemic: implications for post-pandemic models of chronic disease management. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02502-9

Image Credits: AI Generated

DOI: 10.1186/s12902-026-02502-9

Keywords: diabetes mellitus, COVID-19, telemedicine, chronic disease management, glycemic control, HbA1c, preventive screening, SGLT2 inhibitors, GLP-1 receptor agonists, primary care, retinopathy, healthcare utilization