Background  
The coronavirus (COVID-19) pandemic posed significant challenges in the delivery of healthcare necessitating adoption of telehealth in many outpatient services including diabetes services.   
  
There were concerns about telehealth including: inability to conduct physical examinations ,difficulty establishing good rapport ,challenges with providing a review to those not proficient in English   
  
Studies demonstrated telehealth can cause behavioral changes with improvement in glycaemic control whereas other studies have demonstrated that stressors associated with COVID-19 pandemic could affect adherence to therapy. 

Aim  
To examine the impact of telehealth model of care on diabetic management in the COVID-19 pandemic.

Method  
We conducted a retrospective review of patients with diabetes who were reviewed via telehealth with endocrinologists in 2 metropolitan Sydney Hospitals (Liverpool and Fairfield Hospital) between April to September in 2020 in comparison to the same 5 months in 2019 where patients were assessed face-to-face. Their demographics, attendance rate, glycaemic control and unplanned admissions were evaluated. 

Results  
Attendance rate improved with telehealth consultations (884 out of 994 [88.9%] in 2020 vs. 818 out of 959 [85.2%] in 2019, p=0.016).Amongst the 629 patients who had been with the clinic service for at least 12 months, adjustments to diabetic therapy were made less frequently in telehealth consultations than during face-to-face consultations (55.6% in 2020 vs 71.5% in 2019, p<0.001).Glycaemic control improved during the pandemic (HbA1c 7.8±1.4% [62±15mmol/mol]) compared to 12 months prior (8.2±1.7% [66±19mmol/mol], p<0.001), however patients were less likely to have HbA1c results available at time of review (83% during pandemic vs 96% 12 months prior, p<0.001).There was no significant difference in unplanned admissions (58 [9.2%] in 2020 vs 75 [11.9%] in 2019, p=0.100).

Discussion  
This study demonstrated that attendance and glycaemic control improved, and unplanned admission rates did not change in patients who received care via telehealth during the COVID-19 pandemic in comparison to the pre-COVID-19 period. Telehealth thus was an important and viable option for healthcare delivery during the COVID-19 pandemic. Its role in outpatient consultations in the post-COVID-19 era is yet to be defined, with emerging evidence telehealth should be considered to compliment face-to-face consultations.

References  
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Telehealth utilization in Diabetes Centre during COVID Pandemic in South-Western Sydney: An evolving model of care