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

Abstract

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.

Effect of COVID-19 lockdown on glycated haemoglobin testing and utilisation in KwaZulu-Natal, South Africa

“…Studies conducted in China in 2022 and Taiwan in 2021 found no significant difference in HbA1c results between the pandemic and pre-pandemic periods. 33 , 34 Remarkably, a study conducted in Spain in 2021 instead reported improved glycaemic control during the pandemic, and this was supported by two systematic reviews and meta-analyses performed in the United Kingdom and Germany in 2021. 35 , 36 , 37 In contrast to the findings of these studies, we found a significant increase in the average HbA1c result during the pandemic of 2.2 mmol/mol (0.2%) overall and in nine of the districts, indicating poorer glycaemic control during the pandemic where decreased numbers of HbA1c tests were being conducted.…”

Endocrine manifestations of COVID-19 in children: A scoping review

“…Many studies (involving 1498 children/adolescents) reported improved glycaemic control (including increased time-in-range, and reduced time-above-range, time-below-range and coefficient-of-variation in blood glucose levels, and lower HbA1C) during lockdown, compared with pre-pandemic values ( Table 1 ). It is believed that extra vigilance and increased compliance with medication during the pandemic could have accounted for improved glycaemic control [17] , [38*] , [40] , [48] . However, four other studies involving 465 children/adolescents with type 1 diabetes reported worsened glycaemic control during the pandemic [15] , [33] , [34] , [43] ( Table 1 ).…”

Multiple influences of the COVID-19 pandemic on children with diabetes: Changes in epidemiology, metabolic control and medical care

“…The recent meta-analysis by Han et al [ 55 ], which collected data of 2106 pediatric patients including the afore-mentioned studies, confirmed that, as a whole and compared with the pre-lockdown period, glucose had significantly decreased both during and after lockdown. Furthermore, the improvement was also found for many metrics, i.e.…”