Reconnecting diabetes patients and health-care providers during the shadow pandemic of chronic disease

By Ann Besner

COVID-19 has had a monumental effect on the health-care system since the pandemic was declared well over a year ago. Access to all levels of care has been significantly disrupted, with many services still far from operating as usual. People’s reticence to access the health-care system for non-COVID-related care has been evident over time. Across the country, emergency department visits dramatically declined by nearly 25,000 a day last spring. In Manitoba, Ontario and Nova Scotia, there was a decrease of 13 to 33 per cent in patient visits to all types of physicians between March and June 2020. Of people clinically diagnosed with a chronic disease who participated in a national survey, 38 per cent reported avoiding the health-care system altogether.

Patients can hardly be blamed for ‘disappearing’ from the system– it has been a very confusing and frightening time for people. Whether it’s because they have been trying to abide by public health regulations to stay home, they are concerned about the possibility of contracting COVID in their doctor’s waiting room or they are reluctant to further burden an overtaxed system, huge numbers of patients have stayed away from hospitals and medical practices during the pandemic. This has resulted in their health essentially being put on hold.

But the pandemic hasn’t made chronic diseases disappear. In fact, it has caused certain aspects of management to be much more difficult for many people, including those with diabetes. Under normal circumstances, people with diabetes have a higher risk of a host of health issues from heart disease to major depressive disorder, and an all-cause mortality rate twice that of those not living with diabetes. Now, the pandemic has resulted in access to care challenges and delays in treatment that are contributing to the worsening of Canadians’ physical and mental health.


Patients must be empowered to reclaim space in the health-care system

People with chronic disease require support with their management. And they need to know that it is okay to reclaim their place in the health-care system. Not only is it acceptable and safe to do so, it is important for good health. Those living with diabetes should be seeing their health-care team on a regular basis for check-ins, routine blood work and important diabetes tests. When these visits go by the wayside, there is a risk that diabetes management can get off-track or that problems may not be identified and addressed in a timely manner. This can lead to short- and long-term complications and poorer health outcomes.

Diabetes Canada urges people living with diabetes to prioritize their health and resume their regular diabetes visits. People experiencing difficulty with their management should follow up with their team as soon as possible to book an appointment. Those who have not been seen in awhile who feel their diabetes is well-managed at present are still strongly encouraged to schedule a non-urgent visit to reconnect.

Virtual care improves access to services and supports across many populations

A lot of care is happening virtually these days. The shift in delivery model happened quite rapidly in the first wave of the pandemic; by April 2020, 52 per cent of care was being conducted through the phone or online. Over the course of the last year, a number of medical practices have adopted a hybrid model of care, wherein certain visits still occur in-person at the clinic, but others are conducted virtually, whether by phone, video chat or secure messaging. There is research to suggest that a hybrid model of care “may lessen the impact of public health measures required to prevent the spread of COVID-19 on chronic disease outcomes, and close health equity gaps in the long term”.

Many patients have come to appreciate and embrace virtual care. In a survey of people living with diabetes conducted by Diabetes Canada in June 2020, patients overwhelmingly reported enjoying virtual visits. They found it a convenient way to access their providers and most even said they would prefer more virtual visits in future after COVID ends.

To facilitate the continued transition to virtual diabetes care and increase patients’ comfort with this type of interaction, which is new and different for many, Diabetes Canada has developed a variety of educational resources that are accessible online. A number of other health charities, advocacy groups and medical professional associations have also assembled useful online tools and materials on their own sites to help patients and practitioners learn more about, and adapt to, virtual models of care.

Chronic disease care is essential to a healthy population, in COVID times and beyond

Welcoming people back to care, whether in-person, virtual or some combination of the two, and inviting them to re-establish a relationship with their health-care team will go a long way to mitigating some of the long-term negative impacts of the pandemic on Canadians with chronic disease. Diabetes care matters and should be optimized to allow people to live their best lives, during COVID and far into the future.

Ann Besner is a Registered Dietitian and the Manager of Research and Public Policy with Diabetes Canada. Her areas of expertise include chronic disease prevention and management specializing in diabetes, health and nutrition policy development and analysis, person-centred care and Canadian healthcare systems improvement.