Background
To explore type 1 diabetes incidence patterns during the pandemic years 2020 and 2021 in Czechia, to compare them to the trends from the previous decade, and to test its association with indicators of containment measures and of pandemic severity (school closing and the all‐cause excess mortality).
Methods
The Czech Childhood Diabetes Register is a population‐based incidence register recording patients age 0–14.99 years at diabetes onset. Type 1 diabetes incidence in the pandemic period (April 2020–end of observation Dec 2021) was compared by Poisson regression models to the incidence patterns over the past decade 2010–2019.
Results
During the pandemic years 2020–2021, 956 children 0–14.99 years old manifested with type 1 diabetes in Czechia. The observed incidence (27.2/100,000/year) was significantly higher than what was expected from the trends over 2010–2019 (incidence rate ratio, IRR = 1.16, 95%CI 1.06–1.28,
p
= 0.0022). The incidence had a trough during the first lockdown (March–May 2020), then it rose above expected values with no usual summer decrease. The assessed pandemic indicators (school closing and all‐cause excess mortality) were not associated with the incidence levels.
Conclusions
The COVID‐19 pandemic was associated with a notable upward inflection of the type 1 diabetes incidence curve; the early months of the first lockdown were however hallmarked by a significant dip in new diabetes diagnoses. Long‐term observation will show whether the increased incidence originated only from accelerating an advanced preclinical Stage 2 to overt diabetes, or whether the pandemic triggered new cases of islet autoimmunity.
Objective
Increased access to modern technologies is not always accompanied by a decrease in HbA1c. The aim of this study was to identify changes in the proportion of continuous glucose monitoring (CGM) users since 2017, when general reimbursement for CGM became effective in Czechia, and to test whether HbA1c is associated with the percentage of time spent on CGM.
Research design and methods
All T1D children in the Czech national ČENDA registry (3197 children) were categorized according to their time spent on CGM and associations with age, sex, center size, and HbA1c were tested with calendar year as a stratification factor.
Results
The proportion of children with any CGM use increased from 37.9% in 2017 to 50.3% in 2018 and 74.8% in 2019. Of the CGM users, 16%, 28%, and 41% of the children spent >70% of their time on CGM over the 3 years of the study period, with an overrepresentation of children in the <10 years age group versus the older age groups (p < 0.001). The proportion of CGM users differed among centers and was positively associated with a large center size (>100 patients) (p < 0.001). HbA1c was negatively associated with the time spent on CGM (p < 0.001).
Conclusions
A rapid increase in CGM use was reported over the 3 years after general reimbursement. HbA1c was associated with time spent on CGM, a continuing decrease was observed in the >70% category. Reimbursement for CGM likely contributes to the improvement of T1D control at the population level.
AIMS
To assess the differences in key parameters of type 1 diabetes (T1D) control associated with treatment and monitoring modalities including newly introduced hybrid closed-loop (HCL) algorithm in children and adolescents with T1D (CwD) using the data from the population-wide pediatric diabetes registry ČENDA.
MATERIALS AND METHODS
CwD younger than 19 years with T1D duration > 1 year were included and divided according to the treatment modality and type of CGM used: multiple daily injection (MDI), insulin pump without (CSII) and with HCL function, intermittently scanned continuous glucose monitoring (isCGM), real-time CGM (rtCGM), and intermittent or no CGM (noCGM). HbA1c, times in glycemic ranges, and glucose risk index (GRI) were compared between the groups.
RESULTS
Data of a total of 3251 children (mean age 13.4± years) were analyzed. 2187 (67.3%) were treated with MDI, 1064 (32.7%) with insulin pump, 585/1064 (55%) with HCL. The HCL users achieved the highest median TIR 75.4% (IQR 6.3), and GRI 29.1 (7.8), both p<0.001 compared to other groups, followed by MDI rtCGM and CSII groups with TIR 68.8% (IQR 9.0) and 69.0% (7.5), GRI 38.8 (12.5) and 40.1 (8.5), respectively (non-significant to each other). These three groups did not significantly differ in their HbA1c medians (51.8 (IQR 4.5), 50.7 (4.5), and 52.7 (5.7) mmol/mol, respectively). NoCGM groups had the highest HbA1c and GRI and lowest TIR regardless of the treatment modality.
CONCLUSIONS
This population-based study shows that the HCL technology is superior to other treatment modalities in CGM-derived parameters and should be considered as a treatment of choice in all CwD fulfilling the indication criteria.
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