# Pandemic-Related Disruptions in care for Veterans on Insulin Pumps (PD-VIP): A Mixed Methods Analysis

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: Prior to the pandemic, the approximately 10,000 Veterans on insulin pumps (VIPs) were
excluded from VA telehealth programs due to the complexity of their care and their risk of adverse events
(AEs). The lack of enrollment of VIPs in VA telehealth programs resulted in a gap in knowledge of best
practices for remote insulin pump management, making pandemic-related disruptions in care especially difficult
and riskier for these Veterans. The urgency to switch all Veterans to telehealth for non-emergent care during
the pandemic resulted in the need for VIPs and providers to adapt to new care processes and quickly “piece
together” data-sharing technologies to overcome barriers and maintain safe and effective care. The objective
of this study is to address the gap in knowledge of best practices for remote insulin pump management to
mitigate adverse effects the ongoing pandemic has on high-risk VIPs. The long-term goal of this research is to
establish an evidence-based telehealth program for safe and effective remote insulin pump management to
improve access to remote care for VIPs and meet the growing demand for insulin pump therapy.
Significance: This study will inform the advancement of telehealth processes and tools for remote insulin
pump management that will: (1) benefit vulnerable Veterans living in rural communities and other Veterans
who face access challenges, (2) expand care options for Veterans with diabetes who may be candidates for
insulin pump therapy but are unable to access VA specialty care, and (3) enhance VIPs ability to connect with
their care team for critical real-time troubleshooting of unexpected device failures and prevention of AEs.
Expanding Veteran access to remote insulin pump management assures continued quality care and
connection for VIPs and supports VA's clinical and legislative goals of improving Veteran access to care.
Specific Aims:
1. Characterize the pandemic's impact on VIP outcomes, including process of care and clinical
 outcomes. Using a longitudinal observational design, we will examine VIP process of care and clinical
 outcomes over a 3-year period beginning 1.5 years prior to onset of the pandemic. We will use mixed
 effects and Cox regression models to compare outcomes before and during the pandemic while accounting
 for practice, provider, and patient-level covariates that are likely to influence the outcomes of interest.
2. Examine VIPs' and providers' experiences and satisfaction with insulin pump management before
 and during the COVID-19 pandemic and identify barriers to and facilitators of safe and effective
 remote care. We will conduct structured interviews with a VIPs and providers and apply rapid qualitative
 analysis to examine experiences and satisfaction with insulin pump management before and during the
 COVID-19 pandemic and identify barriers to and facilitators of safe and effective remote care.
3. Develop recommendations to advance telehealth processes and tools for safe and eff...

## Key facts

- **NIH application ID:** 10830950
- **Project number:** 5I01HX003581-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Jamie Estock
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-06-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10830950

## Citation

> US National Institutes of Health, RePORTER application 10830950, Pandemic-Related Disruptions in care for Veterans on Insulin Pumps (PD-VIP): A Mixed Methods Analysis (5I01HX003581-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10830950. Licensed CC0.

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