Impact of COVID-19 lockdown on glucose control of elderly people with type 2 diabetes in Italy

Falcetta, Pierpaolo; Aragona, Michele; Ciccarone, Annamaria; Bertolotto, Alessandra; Campi, Fabrizio; Coppelli, A; Dardano, Angela; Giannarelli, R; Bianchi, Cristina; Prato, Stefano Del

doi:10.1016/j.diabres.2021.108750

Cited by 35 publications

(48 citation statements)

References 14 publications

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“…In general, we analyzed n = 1823 T2D patients. Of n = 8 T2D studies, n = 4 (50%) showed clear deteriorations in glycemic control (HbA1c and mean glucose) [ 39 – 42 ], n = 2 (25%) showed stability (no changes) [ 43 , 44 ] and n = 2 (n = 25%) [ 45 , 46 ] improvements. In n = 5 of n = 8 T2D studies, the patients received telemedicine care, but telemedicine was not described in detail, and in n = 3 papers no digital treatments were described.…”

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

136

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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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

136

109

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“…Two studies have indicated that people with T2D have seen their HbA1c rise during COVID [ 27 , 28 ] but in at least one of these studies the rise has been for people with diabetes less than 50 years of age [ 27 ] but not older. Balancing these observations are studies showing that COVID-19 home confinement did not negatively impact glucose control in patients with T2D [ 29 ], although older age and insulin therapy are associated with greater risk of deterioration of glucose control, and a separate study has observed a fall in HbA1c during the COVID restrictions [ 30 ]. A study from the Netherlands found that, during the COVID-19 lockdown, people with relatively well-controlled T1D or T2D showed increased stress and weight gain but no deterioration in glucose control [ 31 ].…”

Section: Diabetes Control In Absence Of Telemonitoringmentioning

confidence: 99%

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

et al. 2021

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People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70–180 mg/dL (3.9–10 mmol/L) increased across 19/27 cohorts with a median 3.3% (− 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.

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“…Increased snacking, poor dietary habits and reduced physical activity have been shown to contribute for worsening of glycaemic status [ 15 , 16 ], and is comparable with our study. Ruiz-Roso et al [ 17 ] demonstrated that patients aged 63 years or younger significantly increased their sugar intake, whereas Falcetta et al [ 18 ] showed that older patients (>80 years) were at risk of worsened glycaemic control during the COVID-19 lockdown. However, age was not an independent predictor of glycaemic control in our study.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 lockdown on people living with diabetes: Experience from a low-middle income country in South Asia

Dissanayake

Soysa

Samarathunga

et al. 2022

Primary Care Diabetes

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Aims COVID-19 lockdown imposes many challenges to patients with diabetes. We aimed to assess the impact of COVID-19 lockdown on health-related behavior and disease control among patients with diabetes. Materials and methods A cross-sectional study was conducted among adults with diabetes attending a diabetes clinic in Colombo, Sri Lanka in June-July 2020. Lifestyle and disease control changes before and during the lockdown, were determined using an interviewer-administered questionnaire and review of medical records. Results Among 1727 participants mean HbA1c decreased by 0.30% (95% CI 0.24−0.36, p < 0.001). HbA1c improved in 37.6% but deteriorated in 18.8%. Male sex (OR 1.36, 95% CI 1.10–1.67), better education (OR 1.10, 95% CI 1.01–1.20) and being employed (OR 1.08, 95% CI 1.00–1.16) were sociodemographic predictors of improved control. Better dietary adherence (OR 1.55, 95% CI 1.13–2.12), night-time sleep (OR 1.46, 95% CI 1.13–1.88) and indoor exercise (OR 1.62, 95% CI 1.23–2.07) were behavioural determinants of improved glycaemia. Decreases in self-monitoring of blood glucose (OR 1.45, 95% CI 1.09–1.93), exercise (OR 1.7, 95% CI 1.32–2.20), medication use (OR 1.95, 95% CI 1.37–2.78), dietary adherence (OR 1.72, 95% CI 1.32–2.26) and family income (OR 1.45, 95% CI 1.12–1.88) predicted worsening glycaemia. Only 4.1% used telehealth services; 83.1% of them reported good satisfaction. Conclusions Mean HbA1c improved during the lockdown. Overall, 37.6% of participants improved their glycaemic control. Well-educated employed men were more likely to improve glycaemic status. Improving diabetes control through healthy lifestyle practices and self-monitoring are feasible even in resource limited settings.

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Impact of COVID-19 lockdown on glucose control of elderly people with type 2 diabetes in Italy

Cited by 35 publications

References 14 publications

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

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

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

Impact of COVID-19 lockdown on people living with diabetes: Experience from a low-middle income country in South Asia

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