Are Telemedicine Appointments Good Enough for Diabetes Care?

Virtual “telemedicine” appointments with your healthcare team were a saving grace during the COVID-19 pandemic. While video calls with a clinician couldn’t meet all your healthcare needs, it certainly helped at the time. 

Today, we’ve returned to routine in-person life but virtual healthcare has become an increasingly normal option when scheduling some of your appointments. Unfortunately, research says telemedicine alone leads to worse health outcomes, emphasizing a need for at least some in-person appointments. 

Can your healthcare team truly provide adequate care through a computer screen? What’s missing? What are the risks vs. the benefits?

Here’s a closer look at the question: when is virtual healthcare appropriate for diabetes?

Healthcare practitioners are concerned: They want to see you in person

It’s easy to forget just how much time diabetes consumes in a person’s life beyond the hour-by-hour management. You’re spending hours every year on the phone with your insurance company. Hours at the doctor’s office. Hours with the pharmacy. And that’s on top of any non-diabetes healthcare needs. Don’t forget primary care visits, mental healthcare, and other health concerns you’re juggling! 

When you stack up all these doctor appointments, it’s no surprise that people with diabetes are still choosing to meet virtually. 

The benefits of virtual appointments are obvious:

No travel
Requires less time
Less time missed at work or school
Skips the long wait in the lobby
Skips the long wait between the nurse and the doctor
Simplifies scheduling for parents
…and more!

While none of these sound like a big deal, they can have a big impact on the stress of your day when you’re juggling multiple appointments or multiple healthcare concerns. Despite the ease of virtual care, the question is still critical to consider: can it meet your needs in diabetes management?

“A lot of people with diabetes in our clinics have gotten used to virtual diabetes care visits,” explains Barbara Liepman, RD, MS, CDCES at UCSF’s Benioff Children’s Hospital. Liepman has supported people with diabetes as a nurse for over twenty years, ever since her own daughter’s diagnosis in 1995. 

While virtual appointments can make getting to the appointment easier, Liepman stresses that it cannot meet all of your healthcare needs. 

“Virtual appointments definitely impede our ability to provide comprehensive care,” says Liepman. “There are just some things that are best accomplished at an in-person medical appointment.”

A recent real-world study of the issue evaluated the diabetes management results of nearly 4,000 adults with type 2 diabetes between 2020 and 2022. The results were clear: Those who received in-person care enjoyed significant A1C improvements compared to those who used only telemedicine. 

The telemedicine-only group saw virtually no improvements in their A1C levels. The group who used a mix of online and in-person appointments saw a moderate improvement in A1C levels ( a drop of 0.22 percentage points), and the in-person group saw the most improvements in A1C levels (a drop of 0.37).

Liepman says in-person appointments are necessary for many reasons:

Completing important health and well-being questionnaires only distributed at in-person appointments due to workflow limitations and for reasons of safety and confidentiality
Completing various exams that can only be done in person like skin, foot, and eye exams
Obtaining certain lab work (like a “Point of Care” A1C) 
Speaking with members of the care team about sensitive issues in a safe, confidential environment
Receiving an annual flu vaccine, if desired
Receiving assistance with diabetes technology and downloading devices, which is often complicated for people with diabetes but is essential for your care team
Meeting the requirements in some states’ health insurance coverage policies that require an annual in-person visit once per year

“There should be a balance of in-person vs. virtual,” says Liepman, for those who do prefer virtual visits. “Everyone should be seen in person at least once per year.”

Asking people with diabetes: What do you prefer?

I recently asked my Instagram community which form of appointment they prefer for diabetes management, and why. 

The most alarming story is worth highlighting.

“In April 2021, I nearly died when it was finally figured out that I was in adrenal failure,” explains Christine, who also lives with type 1 diabetes. “I think one huge factor in the missed diagnosis was the fact that I had no in-person doctor’s visits after March 2020. I was reporting all the classic symptoms including weight loss. I lost 50 pounds in the year before diagnosis, and yet none of my doctors put it all together.” 

“My friends and family could see I was getting sicker and many expressed concern over how much weight I was losing,” adds Christine. “But I don’t think any of my doctors understood how sick I was because there are some things you just can’t see on a computer screen. Even me telling them how much weight I was losing was easy to dismiss if you weren’t seeing it in person. I do believe I would have gotten diagnosed sooner if I had seen even one of my doctors in person.” 

“An occasional virtual visit is fine but they just can’t replace seeing someone in person,” cautions Christine. “There are things you just can’t see on a computer screen.” 

Here’s a look at what others had to say. (Submissions have been edited slightly for clarity.)

“It feels like less of a waste of time if I don’t have to drive all the way to the clinic and pay for parking!” – Rachael

“I live eight hours from my endocrinologist; I can get labs, basic neuropathy tests, and kidney function, etc. at my primary care closer to where I live. My endocrinologist is best for analyzing my Dexcom and pump data, but there’s no way that needs to be done in person.” – Heather
“I feel limited in my diabetes care options with few endocrinologists available near me and few CDCESs that I’m aware of who understand the implications of women’s health on diabetes management. That gap is striking. However, at the end of the day, I’m genuinely grateful to have access to healthcare so I feel bad complaining at all. I hope the future of diabetes care can be more holistic, accessible, and affordable for everyone.” – Julia

“I only have two appointments a year after 19 years with type 2 diabetes. So, I prefer one to be telehealth, one in person to do foot check, thyroid feel, etc.” – Rachel
“They see all the data already on the computer. I can do it from anywhere. Virtual appointments mean there is no drive time and more time to focus on me. As a patient, I love virtual appointments. Also, as a mom of two, it’s hard to take them to appointments and find childcare. Virtual appointments allow me to get there and not have to cancel because of my kids.” – Charlene
“I prefer virtual appointments because I know what I’m doing. I don’t want to waste my time and travel going to an in-person appointment where we just nod at each other!” – Kaili
“If it’s for a regular follow-up or a repetitive health issue, virtual appointments are fine.” – Lydie
“I love the option of virtual appointments. It makes me not dread the appointment as much due to the commute and the wait time. I can sit at my table and have a productive appointment with less stress!” – Casey
“I’d prefer virtual appointments. I’ve always had to drive at least an hour to see an endocrinologist. By the time you factor in the usually long office wait times, it consumes half the day! I have good control. At my appointments, I usually get a pat on the head for compliance and my prescriptions renewed, so I stretch as long between in-person appointments as I can without getting in trouble. Usually about a year. I’d love to chat with my endo three to four times a year though. I would schedule more appointments via telehealth if it was an option.” – Anna
“I prefer face-to-face because I want to know that I’ve been heard when I ask a question or when I share something which is working for me. I can’t know that from a phone review. In-person connection matters. It builds relationships.” – Dawn
“I quite like feeling like the time is for me and given I have to travel over an hour, I would prefer in-person. I find the appointments are beneficial, so I don’t mind attending in person. I feel like I’m treated as a person, not just numbers, and my well-being is considered. During an in-person appointment, you can read body language and they will question if something doesn’t seem ‘okay’.” – Kes
“Virtual appointments are fantastic during pregnancy when you have frequent check-ins, but…my endocrinologist is very cool! I like being around her in person and it’s nice to have access to blood work as needed. Plus, I love the fancy coffee served downstairs at my clinic.“ – Sarah
“I’m not a fan of telehealth. I like my in-person visits. Meeting with your doctor over the computer is not personal to me. I’ve only ever done one.” – Tara
“I feel like I have their 100% undivided attention during an in-person appointment. I can confirm they are focused on my data and my specific questions or concerns. I love my endocrinologist, but telehealth would only be handy for me when I’m pregnant and having monthly visits.” – Taylor
“I live in an area where the endocrinology options are limited and not great. To receive good care, I have to travel two hours and plan around my husband’s schedule because I’m not comfortable making that drive alone. Telemedicine has been a game-changer! Every couple of visits they like to see me in person, but decreasing the number of trips to the big city saves me time, money, and stress.” – Lisa
“Seeing an endocrinologist is sometimes a waste of time. We know how to manage our blood sugars better than they do without the shame and nitpicking.” – Michelle
“I don’t get anything out of going in person except maybe getting weighed and getting my blood pressure checked — both of which I can do at home or with my primary care doctor. My endocrinologist takes forever and is always running late. I’d rather wait at home for a video call than in a waiting room!” – Hayley
“I definitely prefer in-person visits. I enjoy the time with my endocrinologist.” Lisa
“The benefit, for me, of virtual healthcare is that the closest endocrinologist accepted by my insurance is a 90-minute drive. Not having to do an in-person appointment more than once a year is so convenient. But I do feel like the appointment gets rushed via telemedicine because it’s less personal. I don’t think my doctor is doing less, but it’s easier to rush through all the things. I feel like when I do a telemedicine appointment, I have to come prepared with a list because we won’t come to it naturally the way it might feel at an in-person appointment. At the same time, sometimes I also like how concise the appointment seems to be on telemedicine.” – Lily
“I’m housebound due to another chronic illness so if a practitioner doesn’t do telehealth, I just don’t have access to them. Thankfully most doctors will do phone or video appointments now!” – Hayden
“My doctor is 30 minutes away, so I prefer virtual appointments. My in-person appointments seem to always be scheduled for 11:45 am, which messes with my kids’ mealtimes! We like our routine.” – Sarah
“Virtual healthcare reduces the cost of needing so many appointments. I don’t have to take so much time off work or pay for parking.” – Julie

The need for virtual healthcare is clear: It saves people with diabetes time, money, and stress. However, based on clinician concerns, like Liepman’s, it may be time to establish more protocols or guidelines around the frequency of in-person visits. 

If your appointments are rarely in-person, it affects your healthcare team, too.

“When I get to see my patients in person, it gives me a chance to get to know them better,” adds Liepman. “Getting to know people virtually is just not the same.” 

If you haven’t seen your healthcare team in “real life” this year, consider making the drive for your next appointment. 

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