Impact of lockdown in COVID 19 on glycemic control in patients with type 1 Diabetes Mellitus

Abstract

Background and aims COVID 19 is a novel pandemic affecting globally. Although no reliable data suggests that patients of well controlled Type 1 Diabetes Mellitus (T1DM) being at increased risk of becoming severely ill with SARS-CoV2, but lockdown may impact patients with T1DM requiring regular medications and follow up. Hence this study was planned to see the impact of lockdown on glycemic control in patients with T1DM. Methods A cross sectional study was done in T1DM patients in whom a structured questionnaire was administered on follow up within 15 days after lockdown. Data regarding hypoglycemic and hyperglycemic episodes, Diabetic ketoacidosis (DKA), insulin dose missed, regular glucose monitoring, dietary compliance, physical activity, hospitalization during the phase of lockdown was taken. Average blood glucose and HbA1C of lockdown phase was compared with the readings of prelockdown phase. Results Out of 52 patients, 36.5% had hyperglycemic and 15.3% had hypoglycemic episodes. Insulin dose was missed in 26.9%, glucose monitoring not done routinely in 36.5% and 17.4% were not diet compliant during lockdown. Average blood glucose during lockdown phase was 276.9 ± 64.7 mg/dl as compared to 212.3 ± 57.9 mg/dl during prelockdown phase. Mean HbA1c value of lockdown (10 ± 1.5%) which was much higher that of pre lockdown (8.8 ± 1.3%) and the difference was statistically significant (p < 0.05). Conclusion Glycemic control of T1DM patients has worsened mainly due to non availability of insulin/glucostrips during lockdown period. There is a need for preparedness in future so that complications can be minimised.

A cross sectional study reveals severe disruption in glycemic control in people with diabetes during and after lockdown in India

“…Our data mainly consisted of people having type-2 diabetes (87.01%). Recent literature has mainly focused on disrupted glycemic control among type-1 diabetes people [ 19 , 21 ]. Therefore, irrespective of the type of diabetes, there is a need to monitor BGLs in this population.…”

“…On the other hand, only a few papers have discussed the association between the COVID-19 outbreak and its impact on diabetes care in India. However, these studies had a relatively smaller sample size and were primarily conducted during the period of nation-wide lockdown [ [18] , [19] , [20] , [21] ].…”

Clinical considerations in patients with diabetes during times of COVID19: An update on lifestyle factors and antihyperglycemic drugs with focus on India

“…In a study in 143 patients with diabetes in Central India, 39% patients reported worsening of hyperglycemia [ 16 ]. A small study on 52 patients with type 1 diabetes in north India showed a statistically significant increase in average blood glucose and HbA1c during lockdown [ 17 ]. This is in contrast to the findings of improved glycemic control and reduced glycemic variability in studies in type 1 diabetes done in Spain, Italy and United Kingdom [ [18] , [19] , [20] ].…”

Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: evidence from a large-scale multi-country surveillance programme

“…4 health, children's education, behaviours relevant to chronic disease, as well as severe social and financial consequences. [6][7][8][9][10] There is an urgent need to understand how control measures can be further strengthened in South Asia, both to reduce the high rates of ongoing transmission, and to mitigate their unintended adverse consequences.…”