Aims Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with T1D prone to hypoglycemia using standalone continuous glucose monitoring. Methods Patients with T1D prone to hypoglycemia using multiple daily injections and either a Dexcom G5® or a Free Style Libre® CGM systems for at least 6 months under the funding of National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st–14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70–180 mg/dL (TIR). Additional glucometric data were also analysed. Results 92 patients were included: 40 women, age 42.8 ± 3.9 years, disease duration of 23.1 ± 12.6 years. Seventeen patients used Dexcom G5® and 75 Free Style Libre®. TIR 70–180 mg/dL (59.3 ± 16.2 vs 62.6 ± 15.2%), time > 180 (34.4 ± 18.0 vs 30.7 ± 16.9%), >250 (11.1 ± 10.6 vs 9.2 ± 9.7%) and Glucose Management Indicator (7.2 ± 0.8 vs 7.0 ± 0.8%) significantly improved (PL vs WL, respectively, p < 0.05). Time in hypoglycemia remained unchanged. Conclusions Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycemic control by population with T1D prone to hypoglycemia using CGM. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time in hypoglycemia.

Aims Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with type 1 diabetes (T1D) prone to hypoglycaemia using sensor-augmented pump (SAP). Methods Patients with T1D prone to hypoglycaemia using SAP (640G Medtronic-Minimed ® ) for at least 6 months under the funding of a National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd–March 7th and within lockdown (WL), April 1st to 14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70–180 mg/dL (TIR). Additional glucometric data and total daily insulin were also analysed. Results Fifty-nine patients were included: 33 women, age 46.17 ± 13.0 years and disease duration of 30.2 ± 12.0 years. TIR 70–180 mg/dL (67.6 ± 11.8 vs. 69.8 ± 12.0%), time > 180 (28.1 ± 13.6 vs. 25.5 ± 13.1%), time > 250 (6.9 ± 6.1 vs. 5.1 ± 4.8) and estimated HbA 1c (6.94 ± 0.8 vs. 6.75 ± 0.7%) significantly improved (PL vs. WL, respectively, p < 0.05). Time in hypoglycaemia, coefficient of variation, sensor usage and total daily insulin dose remained unchanged. Conclusions Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycaemia control by population with DT1 prone to hypoglycaemia using SAP. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time hypoglycaemia.

We studied three children with severe forms of meningo coccic sepsis and intravascular coagulation having exten sive cutaneous necrosis during their acute illness. After 1 year, two of them showed epiphysiometaphyseal abnormal ities limited to the lower limbs with bowing of the legs and secondary dwarfism. In the third case, bilateral abnonmali ties appeared 4 months after the sepsis and involved the distal tibia, fibula, and talus, as well as the left tansal navic ular. These lesions are extremely rare and to our knowledge have not been reported previously. Case ReportsCase 1 A 7-month-oldboywasadmittedbecauseof 5 hr of restlessness and high fever. He was pale and responded only to painful stimuli.His temperature was 39.5°C; blood pressure, 75/30 mm Hg; white blood cell count, 3,000/mm3; platelets, 30,000/mm3; prothrombin time, 32%; hemoglobin, 1 1 g/dl; and hematocnit, 33%. A spinal puncture showed cloudy cerebrospinalfluid with 70 cells/mm3, 60% of which were neutrophils. In stained smears and cultures, Neisseria meningitidis was isolated.At 2 hr after admission extensive ecchymosis and petechiae appeared and the patient went into shock, recovering after intensive therapy. During his hospital stay, extensive skin necrosis required grafts,as well as amputationof severalphalangesof both hands. Case 2A 9-month-oldboy was admittedafter 12 hr of high fever and obtundation.Petechiaebegan developing3 hr before admission and on admission he was in shock with extensive ecchymosis and petechiae. His liver was palpable 6 cm below the costal margin. His neck was supple. His temperature was 38.5°C;hemoglobin, 11.5 gm/dI; hematocrit, 36%; white blood cell count, 1,25O/mm3; plate lets, 30,000/mm3; and prothrombin time, 14%. His cerebrospinal fluid wascloudyandcontained25 cells/mm3,mostof themneutro phils. In smears and cultures Neisseria meningitidis was isolated.Duringhis hospitalcourse, the extensivecutaneousnecrosisre quired skin grafts and amputation of several phalanges of hands and feet.At 1½ years after dischargehe developedlimpingon the left. Case 3A 4-year-old girl was admitted aften 1 day of vomiting, lethargy, fever of 39°C, and pallor. On admissionshe had extensivepete chiae and nuchal rigidity. Her blood pressure was 70/40 mm Hg; white blood cell count, 3,000/mm3; platelets, 30,000/mm3; pro thnombin time, 32%; hemoglobin, 8.1 g/dI; and hematocrit, 27%.Her cerebrospinal fluid was cloudy and contained100 cells/mm3, most of them neutrophils. In stained smears and cultures, Neisseria meningitidis was isolated. During her hospital stay she had exten sive hemorrhagicnecrosisof the skin, affecting mainlythe lower extremities. She also had pain in both knees and ankles. Radio graphswereunremarkableat that time.At 4 months after discharge she was seen with flexion deformity of the right knee and talipes equinovarus deformity of the feet. Aadiography showed mild irregularities of the distal tibial epiphy siometaphyseabareas but there was necrosis of the lateral aspect of the talar domes( fig. 3). Necrosisof the lef...

No abstract

No abstract