Pharmacists, Telehealth Could Improve Diabetes Care During Emergencies

Consistent insulin therapy has the potential for significantly maintaining glycemic control during health care disruptions such as the COVID-19 pandemic, according to a study published in Pharmacy (Basel).¹ Researchers’ findings show that the integration of telehealth and pharmacist-led interventions can bolster diabetes care during major health care emergencies.

“The onset of the COVID-19 pandemic in March 2020 triggered widespread disruptions across health care systems worldwide, posing challenges for individuals managing type 2 diabetes (T2D),” wrote authors of the study. “The implementation of public health measures, including lockdowns and social distancing protocols, potentially hindered access to routine medical care and medications, exacerbating the difficulties faced by diabetes patients.”

While impacts of the COVID-19 pandemic affected patients and providers all across the world, it was pharmacists that were placed in a unique and unprecedented position once lockdowns were enforced. One of the most important roles pharmacists took on during the pandemic was as immunizers, providing increased access to the COVID-19 vaccine in minimal time.

Researchers determined patients’ glycemic control, or their change in hemoglobin A_1c (HbA_1c) levels, before and during the COVID-19 pandemic. | image credit: dizain / stock.adobe.com

Aside from distributing vaccines at life-saving rates during the pandemic, many pharmacists also became experts on drug-supply chains, telehealth services, ambulatory pharmacy services, digital software, the dispelling of misinformation, and more.²

READ MORE: Q&A: Pharmacists Play Key Role in Expanding Access to CGMs

Furthermore, on top of the role pharmacists undertook to combat COVID-19, they’ve also exhibited significant expertise in the diabetes space before, during, and after the pandemic. According to a study published in Diabetes, Metabolic Syndrome and Obesity, pharmacists’ roles have evolved, making them the key administrators of 5 tasks within diabetes care. Those roles include disease state management, medication review, cost containment, preventative care, and medication adherence.³

While the prominence of diabetes is growing, along with the need for providers to manage patients’ diseases, there is little data on managing insulin for patients with diabetes during a public health emergency disrupting normal flows of care.

“The objective of this retrospective cohort study is to assess the association between insulin use and glycemic control, as measured by changes in hemoglobin A_1c levels, among patients with T2D during the COVID-19 pandemic,” they continued.¹ “This study also explores patterns of medication use that may have contributed to changes in A_1c control.”

Researchers conducted a retrospective analysis of clinical and prescription drug data from family medicine clinics. Their main timeframes included in the study were the pre-COVID-19 period from March 1, 2019, to March 13, 2020, as well as the period during the pandemic, from March 14, 2020, to March 31, 2021.

The researchers’ primary outcome was patients’ glycemic control, or their change in hemoglobin A_1c (HbA_1c) levels. With a controlled HbA_1c defined as below 8%, patients were separated into 4 groups based on their A_1c status before and during the pandemic: uncontrolled, controlled, improved, or worsened. They also explored insulin and non-insulin medication use during these time periods, and whether or not patients increased, decreased, introduced, or discontinued medications during the pandemic.

A total of 992 patients (mean age, 56; 54.5% women) were included in the final analysis.

“As in other studies of diabetic patients during the pandemic, we did not find a worsening of A_1c levels despite disruptions in care among the diabetic patients in 2 safety net family clinics,” wrote the authors.¹ “Our case series review showed that most patients whose A_1c improved were on insulin, compared to those whose A_1c worsened. During the COVID-19 era, this population experienced significant disruptions in diabetes management due to social distancing policies and clinic closures, and other pandemic-related challenges.”

The most notable findings from the researchers’ review were that just a portion (24%) of patients saw any changes in A_1c. While 128 improved and 110 worsened, the main factor highlighted in those that saw improvements was insulin use, whether administered through telehealth services or pharmacist-led interventions.

Their findings suggest that the consistent use of insulin for patients with T2D is the best approach for maintaining A_1c levels during future public health disruptions. While not exclusive to emergency situations, telehealth services and pharmacist interventions took a leap forward and exhibited significant success in improving patient outcomes during the pandemic.

Future research will explore the pharmacist’s role further in managing diabetes during a health care disruption, along with other ways to ensure equity and resilience during times like the pandemic.

“These findings suggest that consistent insulin therapy may have helped maintain glycemic control despite health care disruptions,” they concluded.¹ “This study highlights the importance of sustained medication management and suggests that integrating telehealth and pharmacist-led care could support diabetes control during future health care system challenges.”

READ MORE: Diabetes Resource Center

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References

1. Opara C, White A, Fulda KG, et al. Type II diabetes mellitus and COVID-19: exploring insulin management in patients from family medicine clinics. Pharmacy (Basel). 2025 Jul 4;13(4):93. doi: 10.3390/pharmacy13040093.

2. Pantasri T. Expanded roles of community pharmacists in COVID-19: a scoping literature review. J Am Pharm Assoc (2003). 2022 May-Jun;62(3):649-657. doi: 10.1016/j.japh.2021.12.013. Epub 2021 Dec 24.

3. Orabone AW, Do V, Cohen E. Pharmacist-Managed Diabetes Programs: Improving Treatment Adherence and Patient Outcomes. Diabetes Metab Syndr Obes. 2022 Jun 20;15:1911-1923. doi: 10.2147/DMSO.S342936.