The Impact of the Covid-19 Pandemic on the Well-Being and Diabetes Management of Adolescents With Type 1 Diabetes and Their Caregivers: A Scoping Review

Abstract

The Covid-19 pandemic and its related restriction measures might negatively impact diabetes management and well-being of adolescents with Type 1 Diabetes Mellitus (T1DM) and their caregivers. Accordingly, the present scoping review is aimed at mapping the literature in line with the question “How has the Covid-19 influenced diabetes management and well-being of adolescents with T1DM and their caregivers?”. A systematic search has been conducted through three academic databases. Studies carried out during the Covid-19 pandemic focused on adolescents aged between 10 and 19 years with T1DM and/or their caregivers were included. A total of 9 studies, performed between 2020 and 2021, have been identified. In particular, N = 305 adolescents with T1DM and N = 574 caregivers were considered. Overall, studies were not specific in reporting adolescents’ age, and only 2 studies were primarily focused on the adolescent population with T1DM. In addition, studies were mainly focused on evaluating adolescents’ glycemic control, which remained stable or has improved throughout the pandemic. Contrarily, psychosocial variables have been marginally considered. Indeed, only one study investigated adolescents’ diabetes distress, which remained stable from pre-to during post-lockdown, albeit improving among girls, specifically. As regards caregivers of adolescents with T1DM, studies showed mixed results concerning their psychological state during the Covid-19 pandemic. Prevention measures, which are aimed at supporting adolescents with T1DM during the lockdown, were considered by one study only, showing the favorable role of telemedicine during lockdown for adolescents’ glycemic control. Altogether, the current scoping review has identified many shortcomings of the available literature, which are given by the limited specificity of the age group considered and by the limited consideration of psychosocial variables, particularly their interplay with the medical ones.

The incidence and causes of acute hospitalizations and emergency room visits in adolescents with type 1 diabetes mellitus prior to and during the COVID-19 pandemic: a single-centre experience

“…We observed that during the COVID-19 pandemic the incidence of acute hospitalizations and emergency room visits did not increase compared to the time before the outbreak. Contrary to the predictions made early in the pandemic, forecast- ing a rise in deteriorations of the disease [13], we did not observe a statistically significant difference in the number of acute admissions in the years 2020 and 2021 (16) in comparison to 2018 and 2019 (23).…”

“…Although the trends in recently published research are inconsistent, the majority indicated no deterioration or even an improvement in the management of T1DM patients during the COVID-19 pandemic [13,[19][20][21][22][23]. It is believed that telemedicine visits, use of advanced diabetes technologies (CGM, FGM, hybrid close loop), and improved self-care, as well as parental involvement, significantly contributed to better glycaemic control [15,24].…”

Quality of Life and Psychological Burden of Parents of Children, Adolescents, and Young Adults with Type 1 Diabetes: A Cross-Sectional Study during the Lockdown Period of COVID-19

“…Similarly, in the present study, increased parental distress (as worsening quality of life) is significantly correlated with the highest number of hyperglycemic episodes, the fewest hypoglycemic episodes, and also the basic prognostic factor of parental trait anxiety ( p < 0.05). In order to manage both the disease itself and the parents’ anxiety, which affects their quality of life, some studies propose high parental self-efficacy, associated with better monitoring, and direct interventions in the control and regulation of HbA1c in the children and adolescents [ 16 ]. In the study by Alessi and colleagues, it was found that periods of increased social stress, such as the period of lockdown due to the pandemic, may increase symptoms of anxiety, burden, and mental health disorders in some caregivers of children and adolescents with diabetes.…”

“…Taking the bibliographic references and data into account, it is necessary for healthcare professionals to pay attention to and prioritize educating less-educated parents in the management of their child’s disease. Support is also necessary in cases of low-socioeconomic status families, even including appropriate psychological or financial support or access to appropriate healthcare structures [ 14 , 15 , 16 , 17 , 18 ].…”

Psychosocial Impact of the COVID-19 Pandemic in Racially/Ethnically Diverse Youth With Diabetes

“…In addition, youth with diabetes and their caregivers experienced high rates of financial difficulty, loss of in-person school-based diabetes management support during school closures, and limited access to regular healthcare including in-person physician visits and regular laboratory screenings during the COVID-19 pandemic ( Ismail et al, 2022 ; Jaswaney & Cerdena, 2020 ). It is notable that some studies also suggest resilience in youth with diabetes such that diabetes distress, which refers to “the worries, concerns, fears and threats associated with struggling with a demanding chronic disease like diabetes over time,” may have improved or stayed the same on average during the COVID-19 pandemic ( Bassi et al, 2022 ; Fisher et al, 2019 , p. 803).…”