Diabetes, like hypertension, asthma and heart trouble, is one of those underlying medical conditions that put coronavirus patients at a higher risk of serious complications. As a result, endocrinologists, who are physicians who specialize in the workings of glands and hormones and who are on the front lines of diabetes treatment, have special concerns when treating patients in a time of pandemic. “Shelter-in-place” and “stay at home” policies have complicated the physician-patient relationship in new and unexpected ways.
Recently, the clinical information website Healio.com, which provides news and education to healthcare providers, conducted interviews with endocrinologists and other diabetes specialists around the United States to find out how they are dealing with the COVID-19 crisis. The interviewers found that some endocrinologists are being called upon to put aside their normal clinical practice and help out as internists, but perhaps the biggest issue is the need to adapt to telemedicine and virtual communication while still reserving time for patients who need a personal consultation. These interviews give unique insights into how diabetes doctors are handling the coronavirus situation.
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Richard Auchus, MD, a professor of pharmacology and internal medicine, is one of those who had to wear his internist hat. “Endocrinologists are internists,” he related, “so we are getting bombarded with preparations for inpatient service. Right now, most of my efforts involve keeping up with all of the emails about what is happening in the hospital that I, normally, have nothing to do with.” Dr. Auchus also remarked about the problems of face-to-face contact, both now and in the future: “Our clinic is definitely suffering. We are shifting to video and phone call visits and trying to make sure people have their supplies of insulin and hydrocortisone. We are trying not to kick the can down the road. If people reschedule their appointment for later, well, later will be a backlog, too. We are trying to get done what we can without the face-to-face contact.”
But telemedicine is not always practical, observed Maria Fleseriu, MD, an endocrinologist at Oregon Health & Science University. “My practice is pituitary and adrenal disease,” she told the interviewers, “so we could not move everything to telemedicine. We have patients with urgent needs, losing vision because of large pituitary tumors, for example, and these are the patients we still must see in clinic. We try to take all of the necessary precautions, of course, to decrease risk of infection for patients and healthcare workers.” But conditions are such that she can’t see as many patients as she used to. “I can’t see the patients all of the time,” she reported, “For some, I cannot even send them to the lab. This is probably the most complicated thing…. If the patient already had an MRI, and the MRI shows a tumor is pushing on the eye and it is an older patient, then yes, they need to be seen. Do I want to patient to leave the house if they are not experiencing vision changes? No, probably not…. In normal times, I would see everyone with a large pituitary tumor within two weeks. That was a different time. Now, not getting patients sick is the priority.”
Like Dr. Fleseriu, others of the endocrinologists pointed out the shortcomings of video medicine but nevertheless speculated it might change the practice of medicine dramatically. According to Jonathan D. Leffert, MD, a managing partner at the North Texas Endocrine Center, “To think about how much of a change it is, from walking in and seeing a patient — something I have done for 29 years — to getting on a call and having a face-to-face on a computer, it’s a very different experience. We can’t get a weight, a blood glucose, an HbA1c, all of the things we routinely do during a diabetes visit, we can’t get in this setting. We have to go with what the patient has on their blood glucose meter, or what they have if they’ve downloaded CGM data. We’re limited, definitely.” Alice C. Levine, MD, professor of endocrinology at the Icahn School of Medicine at Mount Sinai Hospital in New York, said she had to improve her computer skills in order to “learn how to do everything — and I mean everything — remotely and efficiently.” She went on to say, “My outpatient practice has changed literally overnight into primarily video visits…. something that neither I nor most of my patients knew how to do before. With the help of a lot of administrative staff, also learning on their feet, we have been able to convert many visits to telemedicine.”
Susan Weiner, MS, RN, CDCES, FADCES, the owner and clinical director of Susan Weiner Nutrition, PLLC, said, “After more than 25 wonderful years of running a successful office-based nutrition, diabetes education, and lifestyle counseling and coaching private practice, I moved to a home-based, virtual HIPAA-compliant platform…. Using a virtual platform allows me to see and connect folks, no matter their current circumstances…. I’m doing all that I can to make this transition as seamless as possible. I’ve decided to lengthen the time of each session, so people who feel isolated do not feel rushed and they can share their concerns.” Theodore C. Friedman, MD, Charles R. Drew University of Medicine and Science in Los Angeles, was the most emphatic analyst of the impact of video consultation. “The move to telemedicine is going in a one-way direction,” he observed, “I don’t think there is any going back to face-to-face visits once patients see the advantage of staying at home and not having to park….. This is going to be a major change in the way we practice medicine, all because of COVID-19.”
Want to learn more about coronavirus and diabetes? Read “Coronavirus and Diabetes: What You Need to Know,” “Healthy Eating During Hard Times” and “Avoiding Coronavirus With Diabetes: Stock Up and Stay Home, CDC Says.”