The Association between Appointment Modality and Medication Management Discussions in High-Risk Older Adults with Type 2 Diabetes

In older adults with type 2 diabetes (T2D), treatment with sulfonylureas (SUs) or insulin is associated with increased risk for severe hypoglycemia leading to falls, cognitive decline, lower quality of life, and death. Safe medication management in older adults requires effective and ongoing doctor-patient communication about self-management, glucose control, and other factors associated with hypoglycemia. In recent years, health care systems have increasingly relied on virtual appointments for chronic disease management. However, research has suggested that at-risk older populations may be less comfortable navigating these virtual spaces. We tested the hypothesis that older adults with T2D on SUs or insulin would be less likely to have conversations with their doctor about changes to diabetes medications during virtual visits (e.g., by video or telephone). Using data from an ongoing clinical trial (NCT04585191), we examined the association of visit modality with patient-reported medication discussions during the visit. We studied 180 Kaiser Permanente Northern California members (age = 81.1±3.8 years, Hba1c = 7.0±0.6%, 56% women, 73% on SUs). Visit modalities included in-person (n = 110, 61%), video (43, 24%), or telephone (27, 15%) appointments with their primary physician. We found that self-reported diabetes medication discussion did not differ by visit modality (48% vs. 44% vs 41%, p = 0.79). These results were unchanged after adjusting for demographic and clinical variables in a logistic regression model (p = 0.82). Qualitative analysis of open-ended surveys found that most adults (59/85, 69%) who engaged in these conversations considered them to be positive experiences that increased confidence in their treatment plan and satisfaction with their physician. Our results suggest that the ongoing expansion of virtual visit options does not deter older adults from discussing diabetes care with their doctor. Disclosure S.Degrace: None. I.Peterson: None. C.Board: None. R.W.Grant: None. Funding Patient-Centered Outcomes Research Institute (CDR-2019C1-16126)