Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes

Samrachana Adhikari, Andrea R. Titus, Aaron Baum, Priscilla Lopez, Rania Kanchi, Stephanie L. Orstad, Brian Elbel, David C. Lee, Lorna E. Thorpe, Mark D. Schwartz

Research output: Contribution to journalArticlepeer-review


Background: While emerging studies suggest that the COVID-19 pandemic caused disruptions in routine healthcare utilization, the full impact of the pandemic on healthcare utilization among diverse group of patients with type 2 diabetes is unclear. The purpose of this study is to examine trends in healthcare utilization, including in-person and telehealth visits, among U.S. veterans with type 2 diabetes before, during and after the onset of the COVID-19 pandemic, by demographics, pre-pandemic glycemic control, and geographic region. Methods: We longitudinally examined healthcare utilization in a large national cohort of veterans with new diabetes diagnoses between January 1, 2008 and December 31, 2018. The analytic sample was 733,006 veterans with recently-diagnosed diabetes, at least 1 encounter with veterans administration between March 2018–2020, and followed through March 2021. Monthly rates of glycohemoglobin (HbA1c) measurements, in-person and telehealth outpatient visits, and prescription fills for diabetes and hypertension medications were compared before and after March 2020 using interrupted time-series design. Log-linear regression model was used for statistical analysis. Secular trends were modeled with penalized cubic splines. Results: In the initial 3 months after the pandemic onset, we observed large reductions in monthly rates of HbA1c measurements, from 130 (95%CI,110–140) to 50 (95%CI,30–80) per 1000 veterans, and in-person outpatient visits, from 1830 (95%CI,1640–2040) to 810 (95%CI,710–930) per 1000 veterans. However, monthly rates of telehealth visits doubled between March 2020–2021 from 330 (95%CI,310–350) to 770 (95%CI,720–820) per 1000 veterans. This pattern of increases in telehealth utilization varied by community type, with lowest increase in rural areas, and by race/ethnicity, with highest increase among non-hispanic Black veterans. Combined in-person and telehealth outpatient visits rebounded to pre-pandemic levels after 3 months. Despite notable changes in HbA1c measurements and visits during that initial window, we observed no changes in prescription fills rates. Conclusions: Healthcare utilization among veterans with diabetes was substantially disrupted at the onset of the pandemic, but rebounded after 3 months. There was disparity in uptake of telehealth visits by geography and race/ethnicity.

Original languageEnglish (US)
Article number41
JournalBMC health services research
Issue number1
StatePublished - Jan 2023


  • Covid-19 pandemic
  • Health disparity
  • Telehealth visits
  • Type 2 diabetes care
  • Veterans

ASJC Scopus subject areas

  • Health Policy


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