Telemedicine in Diabetes Follow-Up: A Narrative Review of Equity Effects Four Years On
DOI:
https://doi.org/10.5281/zenodo.22261623Keywords:
Telemedicine, Health equity, Digital divide, Diabetes follow-up, Video consultationAbstract
Telemedicine expanded abruptly in 2020 and has since settled at a fraction of its peak, with telehealth use among one large
insured population falling from 48 per cent in 2020 to 29 per cent in 2022 and stabilising near 25 per cent. The equity question
has changed shape accordingly. It is no longer whether disadvantaged patients receive remote care but which kind. In an analysis
of 41,583 patients with 127,165 office, 39,484 telephone and 20,268 video visits, those in more deprived neighbourhoods had
higher odds of telephone against office visits, lower odds of video against office visits, and higher odds of telephone against video.
Reporting that combines audio and video under a single heading conceals this. A separate analysis found no compensating
increase in in-person care among the most deprived, the uninsured or those outside metropolitan areas, indicating reduced
contact overall rather than a shift between modalities.
References
Mehrotra A, Bhatia RS, Snoswell CL. "Paying for telemedicine after the pandemic". JAMA 325(2021):431-432.
Rodriguez JA, Betancourt JR, Sequist TD, Ganguli I. "Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic". Am J Manag Care 27(2021):21-26.
Digital inclusion authors. "Digital inclusion pathways to health equity". Health Affairs Health Policy Brief (2026).
Uscher-Pines L, Sousa J, Jones M, Whaley C, Perrone C, McCullough C, et al. "Telehealth use among safety-net organizations in California during the COVID-19 pandemic". JAMA 325(2021):1106-1107.
Deprivation analysis authors. "Telemedicine and health disparities: association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic". PLOS Digit Health 2(2023):e0000255.
Medicare Payment Advisory Commission. "Telehealth in Medicare after the coronavirus public health emergency". MedPAC, Washington DC (2024).
Four-year specialty authors. "From surge to stability: telemedicine use in urology four years after the pandemic". Urol Pract (2025).
Office of the National Coordinator for Health Information Technology. "Individuals access and use of patient portals and smartphone health apps". ONC Data Brief, Washington DC (2024).
Patient characteristics authors. "Telemedicine and health disparities: association between patient characteristics and telemedicine, in-person, telephone and message-based care during the COVID-19 pandemic". Healthc Anal 2(2022):100085.
Chunara R, Zhao Y, Chen J, Lawrence K, Testa PA, Nov O, et al. "Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19". J Am Med Inform Assoc 28(2021):33-41.
Nouri S, Khoong EC, Lyles CR, Karliner L. "Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic". NEJM Catal Innov Care Deliv 1(2020):1-13.
Older adults modality authors. "Disparities in video and telephone visits among older adults during the COVID-19 pandemic: cross-sectional analysis". JMIR Aging 3(2020):e23176.
Mao A, Tam L, Xu A, Osborn K, Sheffrin M, Gould C, et al. "Barriers to telemedicine video visits for older adults in independent living facilities: mixed methods cross-sectional needs assessment". JMIR Aging 5(2022):e34326.
Leff B, Ritchie CS, Rising KL, et al. "Addressing barriers to equitable telehealth for older adults". Front Med 12(2025):1483366.
Crossen S, Glaser N, Sauers-Ford H, Chen S, Tran V, Marcin J. "Home visits for children and adolescents with uncontrolled type 1 diabetes". Diabetes Technol Ther 22(2020):34-41.
Anderson A, O Connell SS, Thomas C, Chimmanamada R. "Telehealth interventions to improve diabetes management among Black and Hispanic patients: a systematic review and meta-analysis". J Racial Ethn Health Disparities 9(2022):2375-2386.
Khoong EC, Butler BA, Mesina O, Su G, DeFries TB, Nickleach D, et al. "Patient interest in and barriers to telemedicine video visits in a multilingual urban safety-net system". J Am Med Inform Assoc 28(2021):349-353.
Diabetes telehealth barriers authors. "Diabetes care in the digital age: addressing telehealth barriers in older adults". Endocrinology Advisor (2025).
Munshi MN, Slyne C, Adam A, Kifley A, Sy S, Toschi E. "Impact of diabetes distress on telemedicine use in older adults with diabetes". Diabetes Care 44(2021):e100-e101.
Lee JY, Chan CKY, Chua SS, Paraidathathu T, Lee KKC, Tan CSS, et al. "Telemonitoring and team-based management of glycemic control on people with type 2 diabetes: a cluster-randomized controlled trial". J Gen Intern Med 35(2020):87-94.
Sim R, Lee SWH. "Patient preference and satisfaction with the use of telemedicine for glycemic control in patients with type 2 diabetes: a review". Patient Prefer Adherence 15(2021):283-298.
Wood CL, Clements SA, McFann K, Slover R, Thomas JF, Wadwa RP. "Use of telemedicine to improve adherence to American Diabetes Association standards in pediatric type 1 diabetes". Diabetes Technol Ther 18(2016):7-14.
Subspecialty disparity authors. "Disparities in telemedicine use for subspecialty diabetes care during COVID-19 shelter-in-place orders". J Diabetes Sci Technol 15(2021):986-992.
Kaufman-Shriqui V, Sherf-Dagan S, Boaz M, Birk R. "Virtual nutrition consultation: what can we learn from the COVID-19 pandemic?". Public Health Nutr 24(2021):1166-1173.
Ortega G, Rodriguez JA, Maurer LR, Witt EE, Perez N, Reich A, et al. "Telemedicine, COVID-19, and disparities: policy implications". Health Policy Technol 9(2020):368-371.
Lyles CR, Wachter RM, Sarkar U. "Focusing on digital health equity". JAMA 326(2021):1795-1796.
Rodriguez JA, Clark CR, Bates DW. "Digital health equity as a necessity in the 21st Century Cures Act era". JAMA 323(2020):2381-2382.
Katzow MW, Steinway C, Jan S. "Telemedicine and health disparities during COVID-19". Pediatrics 146(2020):e20201586.
Hsueh L, Huang J, Millman AK, Gopalan A, Parikh RK, Teran S, et al. "Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic". JAMA Netw Open 4(2021):e2133129.
Weber E, Miller SJ, Astha V, Janevic T, Benn E. "Characteristics of telehealth users in NYC for COVID-related care during the coronavirus pandemic". J Am Med Inform Assoc 27(2020):1949-1954.
