The impact of strict COVID-19 lockdown in Spain on glycemic profiles in patients with type 1 Diabetes prone to hypoglycemia using standalone continuous glucose monitoring

Abstract

Aims Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with T1D prone to hypoglycemia using standalone continuous glucose monitoring. Methods Patients with T1D prone to hypoglycemia using multiple daily injections and either a Dexcom G5® or a Free Style Libre® CGM systems for at least 6 months under the funding of National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st–14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70–180 mg/dL (TIR). Additional glucometric data were also analysed. Results 92 patients were included: 40 women, age 42.8 ± 3.9 years, disease duration of 23.1 ± 12.6 years. Seventeen patients used Dexcom G5® and 75 Free Style Libre®. TIR 70–180 mg/dL (59.3 ± 16.2 vs 62.6 ± 15.2%), time > 180 (34.4 ± 18.0 vs 30.7 ± 16.9%), >250 (11.1 ± 10.6 vs 9.2 ± 9.7%) and Glucose Management Indicator (7.2 ± 0.8 vs 7.0 ± 0.8%) significantly improved (PL vs WL, respectively, p < 0.05). Time in hypoglycemia remained unchanged. Conclusions Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycemic control by population with T1D prone to hypoglycemia using CGM. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time in hypoglycemia.

Real-Time Continuous Glucose Monitoring During the Coronavirus Disease 2019 Pandemic and Its Impact on Time in Range

“… 1 Earlier studies from Italy 2–5 have used CGM and flash glucose monitoring data to associate the pandemic with variable improvements in time spent in the 70–180 mg/dL target range (TIR). Similar findings have been reported for CGM users in Spain 6 and England. 7 An Israeli study noted associations between pandemic-related changes in TIR and socioeconomic status.…”

COVID-19 and diabetes mellitus: from pathophysiology to clinical management

“…Several groups from Italy, Spain and the UK have reported that patients with T1DM and without COVID-19 have shown no deteriorations in glycaemic control, and often even show improvements in control, during the pandemic compared with a control period before the pandemic 131 – 133 . During lockdown, self-reported physical activity was found to be reduced 133 , 134 and more consistent patterns of nutrient intake and sleep were found 133 ; these findings might reflect conditions under which glycaemic control is easier to achieve.…”

COVID-19 associated with diabetes and other noncommunicable diseases led to a global health crisis

“…Authors reported BG worsening in Brazil, India, China and African countries [16,31,33,35,36], while the opposite situation was observed in T1D groups in high income countries (HIC). With access to advanced technology, treatment, specialized services and HCPs used to digital health tools, PwD in HIC maintained or even improved their BG level during the pandemic [59,61,72,73,74]. In a study in Spain, time in range of individuals with T1D using glucose sensors increased, in comparison with the pre-pandemic period, from 57.8% to 62.5% [73], and from 55.8% to 58.2%, in Italy [61].…”