LAUSR

Objective: As the global pandemic caused by the SARS-CoV-2 virus continues unabated, healthcare delivery has been altered significantly impacting patients and providers. We examined the impact of COVID-19 on pediatric endocrinology practice and the challenges faced in pediatric diabetes care. Methods: A 27-item electronic survey was designed, pilot-tested, and deployed to pediatric endocrinology providers using the e-mail discussion lists of the American Academy of Pediatrics, Section on Endocrinology, and the Pediatric Endocrinology Clinical Case Mailing List (May and June 2020). The survey had questions regarding changes in practice, telemedicine use, and observed changes in diabetes disease manifestation. Results: 114 unique responses were analyzed, 79.3% were female respondents. Most (95.6%) providers surveyed were practicing in the United States, and 87.7% reported a decline in their patient volume. Telemedicine use was common [97% (95% CI: 92.4% - 99.4%)] and recent [83.3% (95% CI: 75.2% - 89.7%)] with 98% utilizing remote glycemia monitoring tools. Children with diabetes in underserved and remote locations faced significant barriers to telemedicine use such as lack of connectivity (61%), and devices (59%). Negative consequences on health due to the pandemic included, delay in diabetes diagnosis (33.3%), lack of follow-up (22.0%) and higher diabetic ketoacidosis cases (22.0%). Increased anxiety was commonly reported (66%). Conclusion: The COVID-19 pandemic has led to decline in patient volumes, with rapid adaptation to telemedicine use. Providers noted negative effects due to the pandemic on diabetes care including mental health. Benefits from telemedicine use were observed with a digital divide in underserved populations.