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The COVID-19 pandemic disrupted many healthcare-related activities. This study analyzed the long-term effects of these disruptions on veterans with diabetes.

Many groups that rely on routine, in-person healthcare were expected to experience at least partial disruptions due to the COVID-19 pandemic, as confirmed by emerging studies. However, the full impact that the pandemic had on healthcare utilization among patients with type 2 diabetes is not fully understood on the basis of studies that rely on early pandemic data. This study, published in BMC Health Services Research, analyzed trends in healthcare utilization among U.S. veterans with type 2 diabetes before, during, and after the onset of the COVID-19 pandemic. The analysis looks at the use of both in-person and telehealth visits, along with demographics, glycemic control, and geographic region.

Understanding the Demographics of Veterans with Diabetes

The data used for this study was gathered from a large national cohort of veterans who received new diabetes diagnoses between January 1, 2008, and December 31, 2018. The sample included 733,006 veterans with diabetes who had at least one encounter with the Veterans Administration between March 2018 through 2020, with additional data gathered through March 2021. The authors looked at monthly rates of glycohemoglobin A1c (HbA1c) measurements, in-person and telehealth outpatient visit rates, and prescription fills for diabetes and hypertension medications before and after March 2020, during which most of the effects of the pandemic were felt for the first time. A log-linear regression model was used to analyze the data, and secular trends were modeled with penalized cubic splines.

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The Pandemic Disrupted Diabetic Care, but Only Temporarily

In the 3 months following the onset of the pandemic, large reductions in monthly rates of HbA1C measurements were observed, from 130 per 1000 veterans to 50. In-person visits decreased from 1830 to 810 per 1000 visits, but the monthly rate of telehealth visits doubled over the same time period. Telehealth use varied across various metrics and showed the lowest increase in rural areas and by race/ethnicity. Non-Hispanic Black veterans showed the greatest increase in the use of telehealth. No change was found in overall prescription fill rates for hypertension medication, though fill rates for diabetes medication increased slightly after July 2020. Combined in-person and telehealth outpatient visits returned to pre-pandemic levels after 3 months.

The authors conclude that although healthcare use among veterans with diabetes was disrupted, the effects of this disruption were short-lived and unlikely to have had a major impact on the health of this cohort. Additional research would be needed to better understand disparate trends in the adoption of telehealth technology among rural veterans.


Adhikari, S., Titus, A. R., Baum, A., Lopez, P., Kanchi, R., Orstad, S. L., Elbel, B., Lee, D. C., Thorpe, L. E., & Schwartz, M. D. (2023). Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes. BMC Health Services Research, 23(1), 41. https://doi.org/10.1186/s12913-023-09057-8