Abstract: The impacts of the rapid transition to telehealth care among Veterans on insulin pumps (VIPs) at the onset of the COVID-19 pandemic have not yet been studied. We performed a longitudinal analysis of VIP outcomes from October 1, 2018 to September 30, 2021 using mixed effects logistic regression to assess changes in VA care delivery and VIP outcomes. Among 11,758 VIPs, adjusted odds of VIPs experiencing diabetes specialty care appointment delays increased by 31% in the first pandemic quarter and 44% in subsequent pandemic quarters. Adjusted odds of VIPs completing HbA1c testing decreased by 75% in the first pandemic quarter and 23% in subsequent pandemic quarters. No increases were found in the percentage of VIPs with poor diabetes control, diabetes-related emergency department or inpatient admissions, or all-cause mortality. VA telehealth expansion during the COVID-19 pandemic was associated with disruptions in care delivery, but the percentage of VIPs with adverse diabetes outcomes did not increase.