Youth with Type 1 Diabetes Had Improvement in Continuous Glucose Monitoring Metrics During the COVID-19 Pandemic

Abdulhussein, Fatema; Chesser, Hannah; Boscardin, W. John; Gitelman, Stephen E.; Wong, Jenise C.

doi:10.1089/dia.2021.0131

Cited by 7 publications

(9 citation statements)

References 19 publications

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“…Significant reductions in testing for hemoglobin A1c, an indicator of average blood glucose levels over the previous 2–3 months, were reported in 2020 ( 5 ). Use of telemedicine ( 8 ) or continuous glucose monitoring ( 9 ) might help improve glycemic control during the COVID-19 pandemic. However, others have reported worsening of glucose control through telehealth ( 10 ) and lower satisfaction with telehealth visits among persons with diabetes ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic — United States, February–March 2021

Czeisler¹,

Barrett²,

Siegel³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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Section: Discussionmentioning

confidence: 99%

Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic — United States, February–March 2021

Czeisler¹,

Barrett²,

Siegel³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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“…Among Italian youth using rtCGM and telehealth for T1D management during the initial 3 months of the COVID-19 pandemic, time in range increased and coefficient of variation decreased despite decreased physical activity and no significant changes in total daily insulin dose [34]. Similar single-centre studies in the United States have confirmed these observations [35,36]. An international panel of healthcare professionals, researchers, patient advocates and industry representatives recently published recommendations for the use of digital technologies and telehealth within a digital/virtual diabetes clinic.…”

Section: Continuous Glucose Monitoringmentioning

confidence: 80%

Monitoring of paediatric type 1 diabetes

Marks

Wolfsdorf

2022

Current Opinion in Pediatrics

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Purpose of reviewThis article reviews recent developments in methods used to monitor paediatric type 1 diabetes (T1D), including an examination of the role of glycated haemoglobin (haemoglobin A1c) and its limitations for long-term assessment of glycaemia in individual patients, self-monitoring of blood glucose, continuous glucose monitoring (CGM) systems and ketone monitoring. Recent findingsMonitoring of glycemia and ketones, when indicated, is a cornerstone of paediatric T1D management and is essential to optimize glycaemic control. Ongoing technological advancements have led to rapid changes and considerable improvement in the methods used to monitor glucose concentrations in people with T1D. As a result of recent innovations that have enhanced accuracy and usability, CGM is now considered the optimal method for monitoring glucose concentrations and should be introduced soon after diagnosis of T1D. SummaryPatients/families and healthcare providers must receive comprehensive education and proper training in the use of CGM and interpretation of the vast amounts of data. Future challenges include ensuring equal access to and optimizing clinical use of CGM to further improve T1D care and outcomes.

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“…When the COVID-19 pandemic first prompted the delivery of healthcare to transition its historical in-person model to telemedicine, there were initial concerns that restriction in access to care may have deleterious consequences for people living with diabetes. In the short term, CGM-based studies assuaged these concerns, reporting no deterioration and oftentimes a modest improvement in metrics of glycemic control during strict COVID-19 lockdowns [3][4][5][6][7][8][9][10][11][12][13][14][15]. However, as lockdowns were lifted it was unclear whether these initial gains would be sustained or replaced.…”

Section: Discussionmentioning

confidence: 99%

“…For people living with type 1 diabetes, however, the transformation in the way healthcare is accessed has coincided with a technological transformation with improvements in, and improved access to, wearable devices for insulin delivery and glucose monitoring. In the acute aftermath of the public health lockdowns, data from glucosesensing devices revealed that, contrary to initial expectations, glycemic control did not deteriorate in people with type 1 diabetes following 'stay-at-home' orders and, in many cases, there were modest improvements [3][4][5][6][7][8][9][10][11][12][13][14][15]. Several, explanations have been given for the absence of deterioration and possible improvement of glycemic control in people with type 1 diabetes during COVID-19 lockdowns.…”

Section: Introductionmentioning

confidence: 99%

“…In an effort to smooth the transition during the emerging adult years, many centres including our own provide dedicated, multidisciplinary young adult or 'transition' clinics for those with diabetes transitioning from pediatric care [22]. Whereas some previous reports of glycemic control in type 1 diabetes during the COVID-19 pandemic have included emerging adults within their analyses [5,10,12], there is a dearth of literature as to how this at-risk group fared in particular. The City of Toronto state of emergency lasted a total of 777 days before it was finally lifted on 9 May 2022 [26], making it one of the longest running COVID-19 state of emergencies in the world.…”

Section: Introductionmentioning

confidence: 99%

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Sustained Improvement in Glycemic Control in Emerging Adults with Type 1 Diabetes 2 Years After the Start of the COVID-19 Pandemic

Swaich

Advani

2022

Diabetes Ther

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Introduction Although there were initial concerns that the public health response to the COVID-19 pandemic would adversely affect glycemic control in people with type 1 diabetes, several early continuous glucose monitor (CGM) studies reported an unexpected slight improvement in glucose metrics. Early emerging adulthood (roughly spanning the ages of 18–24 years) is often a vulnerable time in the life of a person with type 1 diabetes. Here, we set out to determine how the care and glucose management of emerging adults with type 1 diabetes changed over a period of approximately 2 years from the start of the COVID-19 pandemic. Methods This was a retrospective study of a tertiary referral, multidisciplinary young adult diabetes clinic, spanning before and after the 777-day state of emergency in the City of Toronto. Results Of 130 emerging adults with type 1 diabetes (80 male, 50 female; mean age 21.0 ± 2.1 years), baseline pre-pandemic HbA 1c values were available for 120 individuals. During 24.9 ± 5.4 months of follow-up before and after the start of the COVID-19 pandemic, HbA 1c fell from 8.5 ± 1.7% (69.3 ± 18.8 mmol/mol) to 8.1 ± 1.9% (65.2 ± 20.5 mmol/mol) ( P < 0.05), with change in HbA 1c from pre-lockdown levels being sustained throughout the second year of the pandemic. Over the same period, CGM use rose from 43% to 83%, primarily through increased uptake of intermittently scanned CGM, which is covered through the Ontario Drug Benefit program. Change in HbA 1c was most evident in Dexcom G6 real-time CGM users − 0.7 ± 1.2% (− 9.8 ± 17.1 mmol/mol) ( P < 0.01 vs. self-monitoring of blood glucose). Conclusion Among emerging adults with type 1 diabetes attending a multidisciplinary clinic in a high-income country, glycated hemoglobin levels are on average 0.4% (4.1 mmol/mol) lower than they were before the pandemic. This reduction in HbA 1c is unlikely to be a consequence of early strict lockdowns given the length of time of follow-up. Rather, improved glycemic control coincided with increased utilization of wearable diabetes devices.

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Youth with Type 1 Diabetes Had Improvement in Continuous Glucose Monitoring Metrics During the COVID-19 Pandemic

Cited by 7 publications

References 19 publications

Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic — United States, February–March 2021

Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic — United States, February–March 2021

Monitoring of paediatric type 1 diabetes

Sustained Improvement in Glycemic Control in Emerging Adults with Type 1 Diabetes 2 Years After the Start of the COVID-19 Pandemic

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