Adherence to Diabetes Medications and Health Care Use During the COVID-19 Pandemic Among High-Risk Patients

The COVID-19 pandemic caused potentially disruptive shocks to chronic condition care. We examined how diabetes medication adherence, related hospitalizations, and primary care use changed in high-risk veterans prepandemic and postpandemic.

We conducted longitudinal analyses on a cohort of high-risk diabetes patients in the Veterans Affairs (VA) health care system. Primary care visits by modality, medication adherence, and VA acute hospitalizations and emergency department (ED) visits were measured. We also estimated differences for subgroups of patients by race/ethnicity, age, and rural/urban location.

Patients were 95% male with mean age 68 years. Prepandemic patients received a mean per quarter of 1.5 in-person primary care visits and 1.3 virtual visits, 0.10 hospitalizations, and 0.22 ED visits, with mean adherence of 0.82. The early pandemic was associated with fewer in-person primary care visits, more virtual visits, fewer hospitalizations and ED visits per patient, and no change in adherence; there were no midpandemic versus prepandemic differences in hospitalizations or adherence. Black and nonelderly patients had lower adherence during the pandemic.

Adherence to diabetes medications and primary care use remained high for most patients even though virtual care replaced in-person care. Black and nonelderly patients may require additional intervention to address lower adherence.