By Cheryl Alkon
Virtual visits with your diabetes care team are here to stay. The biggest tip for telehealth success that we’ve received from healthcare professionals is to actively prepare for your virtual visit – here’s how, so you won’t waste any time.
Telemedicine developed as COVID-19 sent the world into quarantine, and many people sheltered at home. By now, you might have been using telehealth for months, or maybe you just recently tried your first virtual appointment, or you haven’t yet used any remote care options. Regardless, you’ve likely experienced firsthand or have heard about the challenges – and benefits – of setting up and using telehealth services. Experts say that virtual visits with your diabetes care team are likely to continue even beyond the pandemic – so it’s important to start thinking about how to make the most of your telehealth appointments now.
“This has become almost the new normal care model for people with diabetes,” said Dr. Robert Gabbay, the chief scientific and medical officer for the American Diabetes Association, in an interview with diaTribe. “It is here to stay,” agreed Dr. Scott Isaacs, an advisor for the American Association of Clinical Endocrinology, medical director of Atlanta Endocrine Associates, and adjunct assistant professor at Emory University School of Medicine. “Most providers currently using telemedicine plan to continue to some degree.” Dr. Isaacs suggested an optimal scenario for someone with diabetes who sees their healthcare team every three months: telehealth visits every six months, with in-person visits in between. Not everyone can see their diabetes care professional every three months (virtually or in-person), so talk to your care team about how often you should be visiting.
Telehealth visits, also called telemedicine, virtual, or video visits, occur when a healthcare professional and their patient connect through teleconferencing technology. With the person at home and the healthcare professional either at home or in an office, people connect using the Internet, a video camera, and specific, secure software installed on a desktop or laptop computer, tablet, or smartphone. When successful, such visits allow both sides to connect wherever they are based, which allows people to avoid unnecessary travel time, expenses, or parking issues. However, there are some potential challenges including technology glitches, distractions from others (such as disruptive housemates), a lack of privacy at home, cost barriers, and limited access to a high-speed Internet connection. Click here to view diaTribe’s articles and videos on telehealth.
What’s the best way to get the most out of telehealth visits, especially if you haven’t yet had a great experience? Preparation, flexibility, and communication with your care team to know when you should go see a healthcare professional in person and when you can plan for a visit right at home.
Once you have a telehealth visit on the calendar, it’s important to think about what you want out of the visit:
Do you need prescription medication refills?
Do you have questions about your medications or medical devices, or about new prescriptions to help your care?
What physical or emotional things do you want to discuss with your healthcare professional?
Write questions and notes down before the appointment on a piece of paper, rather than in digital form. This way, you can easily read it and take notes while maintaining eye contact with your provider on a video screen.
Upload whatever data you can from your blood glucose meter, insulin pump, or continuous glucose monitor (CGM) so your healthcare professional can see it before the appointment. You can learn about uploading diabetes device data here – make sure to keep on hand the cords and packaging for any diabetes devices you have. It’s helpful to also contact your healthcare office to ask for specific instructions regarding downloading and sharing your data, ideally several days before the appointment. The directions may vary based on what device, software, and other systems you and your healthcare team are using. If your healthcare team isn’t asking for your data, inquire with them about it: “What’s the best way to make sure the office has my data several days ahead of time, so you can look at it?”
Getting the data to the healthcare office ahead of time is crucial – “it’s the most important thing you can do to help your healthcare professional understand your glucose values and patterns,” said Isaacs. Doing so can help you get the best advice on how to make effective changes to your diabetes care routine. Take some time to look at your data so that you are ready to discuss it.
“I like to review individuals’ CGM reports in real-time during the telemedicine appointment, using screen sharing so I can point out areas of concern,” Isaacs added. “I have found that reviewing CGM data and making adjustments to insulin and diabetes medications can be equally if not more effective by telemedicine when patients and providers can view the screen together.”
Besides for your glucose readings, make sure your healthcare professional has accurate information about your medications and technology, how they are going, and is aware of any changes in insulin usage.
It’s also ideal to reach out to the healthcare office at least a week ahead of time – if they haven’t already contacted you – to see if there are other blood tests or lab work that you can get done before your virtual visit so that the results are ready when you connect online. In addition to that, find out if you need to get a blood pressure reading. You can take your blood pressure at home if you have a meter, or ask where you can go to get your blood pressure checked. Finally, it’s helpful to weigh yourself and take a moment to check in with your body, from head to toe, to see if you notice any signs or symptoms of anything to address during your appointment. When the healthcare professional doesn’t have updated lab work or other test results in time for your telehealth (or in-person) appointment, Dr. Gabbay said there’s a challenging catch-up after the visit to share results and discuss next steps. “It is so much better to have that data ahead of time so decisions can be made together.”
You will likely receive information from your healthcare office explaining exactly which technology you will need, which software to use, if you’ll need to adjust your computer’s settings, and how to download any necessary program so that it is already on your device before the meeting starts. Sometimes this is linked to a patient portal, which you will need to log into (and set up an account if this is your first time using it) ahead of the appointment. Keep any information the healthcare office sent you handy so you can find it easily right before your visit. Make sure you ask for help if you need it – telehealth can seem very complicated at the start, but your healthcare team can now “bill” insurance companies for the time it takes to help you get everything set up.
Plan to have the visit in a private area so you can speak honestly and without interruption with your healthcare professional – and where you can be on time. Have a computer, tablet, or smartphone ready to go in that space, or plan to borrow one if you don’t own one of these devices. (If you have access to a car, having the meeting in your parked car is an option if there’s little privacy where you live, as long as you have an Internet connection and you don’t drive during the appointment.)
If you can, make sure your area is well-lit so your image is clear on-screen. Sitting in front of a window can make you appear too dark while the background is bright. A light source in front of you with a plain background is the least distracting.
If possible, test out the tech with plenty of time before the visit begins. If you can’t, and the technology has problems or you can’t figure it out, stay calm.
“Technical difficulties happen all the time,” said Isaacs. “Many clinicians will have a backup form of communication like FaceTime, Skype, Zoom, or a regular phone line without video if all else fails.” Know what the backup options are for your appointment so that you can still connect with your healthcare professional if technical difficulties arise. “People who have repeated technical issues may be asked to reschedule their appointment in the office.” It can be frustrating to lose your appointment if you need to talk with your healthcare professional, so please do what you can to be ready (and early).
It’s important to remember and acknowledge that not everyone has access to the at-home privacy and high-speed internet required for good or great telehealth visits. Some healthcare professionals may be able to conduct telehealth visits by telephone, without the video component to help accommodate you or others in this situation. Don’t let telehealth scare you away from getting the care you need. Talk to your healthcare team about alternative options if you are concerned about poor connection or unavoidable interruptions during your telehealth visit.
The Visit Itself
Be on time for the appointment. “Healthcare professionals tend to keep to a tight telehealth schedule and usually don’t run late like they may in the office,” said Isaacs.
Preparation ensures you won’t miss anything, said Gabbay. “Being in a quiet, uninterrupted place where you can focus on the visit is important, as most people with diabetes say that the visit goes quickly and you will want to make the most out of that time.”
Take notes as your healthcare professional talks, just as you would during an in-person visit. But write them down on a piece of paper, rather than trying to take notes on a device that can distract with alerts and notifications, said Gabbay. Some people record the visit with audio software so that they remember everything (though be sure to ask your healthcare team if this is all right before recording).
Telehealth visits are a good option for routine diabetes management, diabetes medication, insulin adjustments, lifestyle counseling, and diabetes education, said Isaacs. Training on how to use an insulin pen (or an injection pen for other diabetes medications) can also be done efficiently through these visits.
Some things work better at an in-person visit, including:
Checking foot sensation using monofilament testing.
Specific tests based on other diagnoses you may have such as congestive heart failure.
An annual dilated eye exam with an eye care professional. “It’s important to have this done yearly because people can have no symptoms of eye disease but can develop vision-threatening disease,” said Gabbay.
After the Visit
Even if you take your own notes, your healthcare professional may also type information into an electronic medical records system. As a result, the visit summary or other details may be available in a patient portal, or online system you can log into to access your files. These are privacy protected under the Health Insurance Portability and Accountability Act (HIPAA) laws and are more secure than simply sending you the information through email.
“A visit summary is becoming more common in telehealth,” said Gabbay. “The clinics that do it typically offer it through a patient portal, and many will allow appointment data to be communicated there. It’s a good thing to ask if there is a patient portal and what kind of information is available on it. Although online portals have been around for a while, many people didn’t use them that much. But now, they are worth their weight in gold.” We appreciate Dr. Gabbay’s wisdom on the benefits of telemedicine for diabetes care.
Ultimately, a telehealth visit should give you the same value as an in-person one – or more, because of the efficiency and clear focus on data. For people who live far away from a healthcare office, or who have avoided seeing a healthcare professional due to transportation or other challenges, telehealth can help bridge the gap. “The goal of a telehealth visit is for healthcare professionals to provide the same medical care as if you were face to face in the office. You should expect that your telehealth visit will be like a regular office visit, minus the hands-on visit,” said Issacs.
A final note: if you haven’t tried telehealth yet, now is the time to do so! Not only can it help keep you and your loved ones safe – by limiting in-person contact and unnecessary travel to a healthcare office during the pandemic – but it can also save time for you and your healthcare team. To learn more, check out diaTribe’s other resources on telehealth, including a video from, Joslin Diabetes Center's Andreina Millan-Ferro on telemedicine and COVID-19.