The Synergism of Virtual and In-Person Inpatient Diabetes Consultations

The recent study by Luzuriaga et al ¹ comparing in-person to virtual inpatient diabetes consultation during the coronavirus disease (COVID-19) pandemic reported patient-day mean glucose levels of 206.7 and 206.5 mg/dL following in-person and virtual consultations of COVID-19-negative patients, respectively. These results imply similar glycemic outcomes regardless of consultation approach, and virtual reviews may replace in-person consultations. During the pandemic, a virtual approach to care was important to preserve personal protective equipment and minimize viral transmission risk. This study reassures us virtual reviews do not lead to worse glycemia.

However, virtual consults were heterogeneous in Luzuriaga et al’s ¹ study, with some conducted with patients via phone but others solely with relatives or bedside nurses. A more personalized method of virtual consultation could involve telehealth consultation with the patient via video-call. Virtual approaches can be used in a majority of the general hospital population to increase the reach of inpatient diabetes services, but in-person consultation by specialist diabetes health care providers can elicit important clinical and personal insights not evident in the electronic medical record which may benefit subgroups of inpatients with diabetes and acute dysglycemia. In-person consultations often provide greater opportunity to take a richer patient history, perform a physical examination, deliver more impactful education and foster a “connection point” between the person with diabetes as well as hospital-based and community-based providers of diabetes health care.

Inpatient diabetes care is typically a brief component in the continuum of life-long diabetes care; however, it can influence the posthospitalization course. Luzuriaga et al ¹ did not assess posthospitalization outcomes in people who received in-person or virtual reviews. The importance of appropriate discharge planning to reduce hospital readmission risk should be recognized. ² Valuable algorithms to assist diabetes treatment at discharge have been described. ³ Every patient’s hospital journey is unique and the underpinning principle of patient autonomy necessitates a personalized treatment plan based on individual self-management abilities, social circumstances and treatment preferences. People with diabetes desire their health care professionals engage with them collaboratively, ⁴ and lack of treatment consensus and satisfaction is associated with higher blood glucose and lower quality of life. ⁵ In some cases, in-person specialist review and discussion with the patient may be required to understand their unique preferences and circumstances, and thus develop an individualized postdischarge treatment plan.

Virtual platform technologies increase the capacity to provide diabetes consultation services to more inpatients and glucometrics can be used to assess their impact. However, the value of in-person consults to build rapport and enhance communication should not be underestimated. Consultations use a spectrum of information for assessment and management, ranging from remote review of electronic notes to conversing with patients at the bedside. We propose hybrid models of inpatient diabetes care, incorporating both in-person and virtual consultation, are vital for providing holistic care to large numbers of inpatients. When conducting virtual or in-person consultations, taking steps to ensure consultations are as personalized as possible will maximize quality of care and glycemic outcomes.