HbA1c and BMI after lockdown for COVID‐19 in children and adolescents with type 1 diabetes mellitus

Cognigni, Marta; D’Agostin, Martina; Schiulaz, Ingrid; Giangreco, Manuela; Carletti, Claudia; Faleschini, Elena; Barbi, Egidio; Tornese, Gianluca

doi:10.1111/apa.15838

Cited by 9 publications

(11 citation statements)

References 5 publications

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“…In fact, the glycemic control of T1D children on CSII improved without increased number of hypoglycemias. Our results are in line with recent reports on adult T1D patients working from home offices due to the COVID-19 lockdown, and reports on pediatric populations with improvement during the lockdown [ 9 – 11 , 13 , 16 , 17 ]. Interestingly, in our study the improvement of glycemic control was most evident in the patients using conventional insulin pumps while no change was observed in those using HCL pumps.…”

Section: Discussionsupporting

confidence: 93%

“…Di Dalmazi and colleagues reported that glycemic control, measured by continuous glucose monitoring (CGM), slightly improved (less time below range and smaller glucose SD) under lockdown in all children, except in teenagers with T1D [8]. In another study including 50 children and adolescents HbA1c was improved 0.2% (2 mmol/l) without increase in BMI during the lockdown [9], and a study by Marigliano and Maffeis with 233 children and adolescents also shows improved HbA1c, mean glucose and TIR during the lockdown [10], as does another study with 66 children from Piedmont, Italy [11]. Additionally, there are two studies on predictive low-glucose suspend system (PLGS) in children during COVID-19 with contradictory results: Schiaffini et al…”

Section: Introductionmentioning

confidence: 99%

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The effect of COVID-19 lockdown on the glycemic control of children with type 1 diabetes

et al. 2022

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Background Between March 18th and May 13th 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare (i.e. lockdown). Social distancing changed the daily routines of children with type 1 diabetes (T1D). Healthcare professionals were forced to adapt to the pandemic by replacing physical outpatient visits with virtual visits. However, the influence of the lockdown on glycemic control in these patients remained unknown. Methods In this retrospective register study from a pediatric diabetes outpatient clinic, we analyzed the glycemic data of T1D patients (n = 245; aged 4 to 16 years) before and under the lockdown. All the participants used continuous glucose monitoring (rtCGM or iCGM), two-thirds were on insulin pumps (CSII), and one-third on multiple daily insulin injections (MDI) therapy. Results In our patient cohort, time in range (TIR, n = 209) and mean glucose levels (n = 214) were similar prior to and under the lockdown (mean change 0.44% [95%CI: -1.1–2.0], p = 0.56 and -0.13 mmol/mol [95%CI: -0.3–0.1], p = 0.17, respectively). However, children treated with CSII improved their glycemic control significantly during the lockdown: TIR improved on average 2.4% [0.6–4.2] (p = 0.010) and mean blood glucose level decreased -0.3 mmol/mol [-0.6-(-0.1)] (p = 0.008). The difference was more pronounced in girls, adolescents and patients using conventional insulin pumps. Conclusions The glycemic control in T1D children did not deteriorate under the lockdown, and patients on CSII even improved their control, which suggests that social distancing might have allowed families to use the insulin pump more accurately as out-of-home activities were on hold.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The effect of COVID-19 lockdown on the glycemic control of children with type 1 diabetes

et al. 2022

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“…For determining the changes in HbA1c (%) and TIR (%), we pooled appropriate studies and calculated the difference in means, with 95% confidence intervals (CI) before and during/after lockdown. Meta-analysis showed that, compared to the time before lockdown, HbA1c values declined with a mean difference of − 0.05% (95% CI − 0.31 to 0.21) based on n = 11 eligible studies [ 15 , 21 , 23 , 25 , 27 , 28 , 30 , 32 , 36 – 38 ]. In n = 8 (73%) studies in which HbA1c values improved significantly (P < 0.05) due to the “lockdown effect”, the improvements ranged between − 0.1% and − 0.3%.…”

Section: Resultsmentioning

confidence: 99%

Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review

Eberle

Stichling

2021

Diabetol Metab Syndr

125

109

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Background In 2019, a new virus known as severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has emerged. Coronavirus disease 2019 (COVID-19) was classified as a pandemic in a short period of time. In order to reduce the spread of COVID-19, many countries have imposed a lockdown with movement restrictions, social distancing and home confinement, which has affected routine healthcare activities and everyday life. The aim of this systematic review was to examine the impact of the COVID-19 lockdown on glycemic control in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). Methods We systematically identified studies by searching the databases Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, EMBASE, and CINAHL until April 2021. We included n = 33 observational studies of which n = 25 investigated T1D and n = 8 T2D. Results Overall, we analyzed n = 2881 T1D patients and n = 1823 T2D patients. Glycemic values in patients with T1D improved significantly during lockdown. Overall, n = 18 (72%) T1D studies indicated significant improvements in glycemic outcomes. Meta-analysis revealed a mean difference in HbA1c of − 0.05% (95% CI − 0.31 to 0.21) due to lockdown, and in time in range (TIR) of + 3.75% (95% CI 2.56 to 4.92). Lockdown determined a short-term worsening in glycemic values in patients with T2D. Overall, n = 4 (50%) publications observed deteriorations in glycemic control. Meta-analysis demonstrated a mean difference in HbA1c of + 0.14 (95% CI − 0.13 to 0.40) through the lockdown. Moreover, n = 3 (75%) studies reported a not significant deterioration in body weight. Conclusions Glycemic values in people with T1D significantly improved during COVID-19 lockdown, which may be associated with positive changes in self-care and digital diabetes management. In contrast, lockdown rather determined a short-term worsening in glycemic parameters in patients with T2D. Further research is required, particularly into the causes and effective T2D management during lockdown.

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“…Full text of 48 articles were read, and among these, 22 studies with 2106 paediatric patients with T1D were included in the final analysis. Eleven studies compared glucose control between the lockdown and pre-lockdown period (3,4,(11)(12)(13)(14)(15)(16)(17)(18)(19); eight studies compared post-lockdown with pre-lockdown period (5,6,(20)(21)(22)(23)(24)(25)(26); three studies compared both lockdown and post-lockdown with pre-lockdown period (26)(27)(28); In most studies the glycaemic data were collected via CGM or FGM. The characteristics of the included studies are presented in Table 1.…”

Section: Literature Searchmentioning

confidence: 99%

The impact of COVID lockdown on glycaemic control in paediatric patients with type 1 diabetes: A systematic review and meta-analysis of 22 observational studies

et al. 2022

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IntroductionThe COVID lockdown has posted a great challenge to paediatric patients with type 1 diabetes (T1D) and their caregivers on the disease management. This systematic review and meta-analysis sought to compare the glycaemic control among paediatric patients with T1D (aged under 18 years) pre- during, and post-lockdown period.Methods and materialsWe did a systematic search of three databases (PubMed, Embase, and the WHO COVID‐19 Global literature) for the literature published between 1 Jan 2019 to 10 Sep 2022. Studies meeting the following inclusion criteria were eligible for this study: (1) a COVID-19 related study; (2) inclusion of children aged 18 years old or under with established T1D; (3) comparing the outcomes of interest during or after the COVID lockdown with that before the lockdown. Study endpoints included mean difference (MD) in HbA1c, blood glucose, time in range (TIR, 70-180 mg/dl), time above range (TAR, >180mg/dl), time below range (TBR,<70mg/dl) and glucose variability (coefficient of variation [CV]) between pre-lockdown and during lockdown and/or between pre- and post-lockdown period. The MD and its corresponding 95% CI of each endpoint were pooled using random-effect model considering the potential between-study heterogeneity in COVID restrictions and T1D management.ResultsInitial search identified 4488 records and 22 studies with 2106 paediatric patients with T1D were included in the final analysis. Compared with pre-lockdown period, blood glucose was significantly decreased by 0.11 mmol/L (95%CI: -0.18, -0.04) during lockdown period and by 0.42 mmol/L (95%CI: -0.73, -0.11) after lockdown. The improvement was also found for TIR, TAR, TBR, and CV during and post-lockdown (all p values<0.05) except for the post-lockdown TBR (p =0.35). No significant change in HbA1c was observed during and post- lockdown period when compared with the pre-lockdown value. There was moderate to high between-study heterogeneity for most of the analyses.ConclusionCompared with pre-lockdown period, there was significant improvement in T1D paediatric patients’ glucose metrics during and post-lockdown. The underlying reasons for this positive impact warrant further investigation to inform future paediatric diabetes management.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022359213.

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HbA1c and BMI after lockdown for COVID‐19 in children and adolescents with type 1 diabetes mellitus

Cited by 9 publications

References 5 publications

The effect of COVID-19 lockdown on the glycemic control of children with type 1 diabetes

The effect of COVID-19 lockdown on the glycemic control of children with type 1 diabetes

Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review

The impact of COVID lockdown on glycaemic control in paediatric patients with type 1 diabetes: A systematic review and meta-analysis of 22 observational studies

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