Type 1 diabetes and COVID-19: The “lockdown effect”

Abstract

The aim of this study was to evaluate the effect the lockdown imposed during COVID-19 outbreak on the glycemic control of people with Type 1 diabetes (T1D) using Continuous (CGM) or Flash Glucose Monitoring (FGM). Materials and methods: We retrospectively analyzed glucose reading obtained by FGM or CGM in T1D subjects. Sensor data from 2 weeks before the lockdown (Period 0, P 0), 2 weeks immediately after the lockdown (period 1, P 1), in mid-lockdown (Period 2, P 2) and immediately after end of lockdown (Period 3, P 3) were analyzed. Results: The study included 63 T1D patients, (FGM: 52, 82%; CGM:11, 18%). Sensor use (91%) were slightly reduced. Despite this reduction, Time in Range increased in P 1 (62%), P 2 (61%) and P 3 (62%) as compared to P 0 (58%, all p < 0.05 or less) with concomitant reduction in the Time Above Range (P 0 : 38%; P 1 : 34%, P 2 : 34%, P 3 : 32%, all p < 0.05 or less vs. P 0). Average glucose and GMI improved achieving statistical difference in P 3 (165 vs. 158 mg/dl, p = 0.040 and 7.2% (55 mmol/mol) vs. 7.0% (53 mmol/mol), p = 0.016) compared to P0. Time Below Range (TBR) and overall glucose variability remained unchanged. Bi-hourly analysis of glucose profile showed an improvement particularly in the early morning hours. Conclusions: In T1D subjects with good glycemic control on CGM or FGM, the lockdown had no negative impact. Rather a modest but significant improvement in glycemic control has been recorded, most likely reflecting more regular daily life activities and reduces workrelated distress.

How to Best Protect People With Diabetes From the Impact of SARS-CoV-2: Report of the International COVID-19 and Diabetes Summit

“…Specifically, their time out-of-range has decreased since schools were closed in the spring of 2020, suggesting the stay-at-home protocol actually provided a better opportunity for the children to stay in range. Similar data have been reported from Spain 77 and Italy 78 ; however, a study from Israel showed that glycemic metrics for children who use CGMs were similar before and after lockdown started. 79 The panel also highlighted that big data from digital health devices is only useful if you can use it to impact care.…”

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

“…Insulin use also was an independent predictor associated with 2-fold higher odds of glycaemic worsening compared with use of other glucose lowering agents. This may well reflect the increased complexity of the management of this therapeutic approach, particularly for those with T2DM, since evidence currently available for patients with T1DM on continue glucose monitoring show that glycaemic control did not worsen or even improved during lockdown [1,[9][10][11][12]. The latter, however, are younger, on continuous or flash glucose monitoring and more intensively instructed how to handle multiple dose insulin therapy or even continuous subcutaneous glucose infusion.…”

Impact of COVID-19 on Health Economics and Technology of Diabetes Care: Use Cases of Real-Time Continuous Glucose Monitoring to Transform Health Care During a Global Pandemic

“…Although such restrictions impacted the lives of all individuals, people with chronic diseases such as diabetes could have been seriously impacted by restrictions that changed routine diet and physical activity patterns, increased stress and anxiety, and reduced access to health care resources. 26 , 27 Maintaining glycemic control can be affected by all of these factors.…”

“…Interestingly, several recently published studies indicate people with T1D using CGM generally had improved time in range (TIR) and reduced glucose variability. [26][27][28][29][30] For example, Brener et al found CGM metrics in pediatric T1D patients were stable during lockdown in Israel. 28 The same pattern of improved glycemic control for adults with T1D using CGM was found in Spain, 26 Italy, 27,29 and the United Kingdom.…”

“…[26][27][28][29][30] For example, Brener et al found CGM metrics in pediatric T1D patients were stable during lockdown in Israel. 28 The same pattern of improved glycemic control for adults with T1D using CGM was found in Spain, 26 Italy, 27,29 and the United Kingdom. 30,31 Van der Linden (in this issue) compared rtCGM Dexcom G6 data uploaded by >60,000 individual patients before and during the pandemic and found TIR improved on average 2.3% from prepandemic to the early months of the pandemic (March through June 2020).…”