Coronavirus disease (Covid-19): How does the exercise practice in active people with type 1 diabetes change? A preliminary survey

Effects of Two COVID-19 Lockdowns on HbA1c Levels in Patients with Type 1 Diabetes and Associations with Digital Treatment, Health Literacy, and Diabetes Self-Management: A Multicenter, Observational Cohort Study Over 3 Years

INTRODUCTION

Short-term studies reported improved glycemic control and a decrease in eHbA1c (estimated hemoglobin A1c) in patients with type 1 diabetes during COVID-19 lockdown, but long-term changes are unknown. Therefore, the main objectives are to (1) analyze whether laboratory-measured HbA1c changed during and after two lockdowns and (2) investigate potential variables influencing HbA1c change.

METHODS

In this cohort study, 291 adults with type 1 diabetes were followed over 3 years including the prepandemic phase and two lockdowns. The data from medical records and validated questionnaires assessing health literacy (HLS-EU-Q16), diabetes self-management (DSMQ-R27), general self-efficacy (GSE), and social support (F-SOZU-K14) were used to analyze associations with HbA1c levels (N = 2370) by performing multivariable linear regressions.

RESULTS

The median age was 54 (38-63) years and 159 (54.6%) were male. All phases of the COVID-19 pandemic were associated with a significant increase in laboratory-measured HbA1c levels in percent (e.g., during first lockdown β = 0.23, 95% confidence interval (CI) 0.07-0.39, p = 0.005; during the second lockdown, β = 0.27, 95% CI 0.15-0.38, p < 0.001). HbA1c change during lockdowns was significantly affected by the number of checkups (β = -0.03, 95% CI -0.05 to -0.01, p = 0.010), the value of HbA1c at previous observation (β = 0.33, 95% CI 0.29-0.36, p < 0.001), educational level (secondary versus tertiary: β = 0.22, 95% CI 0.06-0.38, p = 0.008; primary versus tertiary: β = 0.31, 95% CI 0.10-0.52, p = 0.004), health literacy score (for each point: β = -0.03, 95% CI -0.05 to - 0.002, p = 0.034), and diabetes self-management score (for each point: β =  -0.03, 95% CI -0.04 to -0.02, p < 0.001). The use of continuous glucose monitoring or insulin pump had no effect on HbA1c change.

CONCLUSIONS

Lockdowns can lead to worsening glycemic control in patients with type 1 diabetes. Particularly patients with few check-ups, poor blood glucose values, deficits in diabetes self-management, low health literacy, and a low level of education seem to be at greater risk of worsening glycemic control during lockdowns and, therefore, require special medical care, e.g., through telemedicine.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT04821921.

Adapting to compromised routines: Parental perspectives on physical activity and health for children and adolescents with type 1 diabetes in the UK during COVID-19 lockdown

PURPOSE

To determine how COVID-19 lockdown impacted physical activity (PA) levels, wellbeing, and diabetes management in children (aged 0-17 years) with type 1 diabetes (T1D), from the perspectives of their parent/guardian.

DESIGN AND METHODS

This qualitative descriptive study is part of a larger, parallel mixed-methods design study, which incorporated a cross-sectional survey and semi-structured one-to-one interviews. Interviewees were recruited from the survey, which was distributed to parents of children/adolescents with T1D in the UK. Interviews explored diabetes management, mental and physical wellbeing, changes in PA levels, sleep quality before/during lockdown, and the effects of lockdown on the individual and their family. The interviews were transcribed and the data were analysed thematically.

RESULTS

14 interviews were conducted with parents. Thematic analysis generated a central theme of routine disruption, with four further themes on diabetes management routines, harnessing the opportunities of lockdown, weighing up risk, and variable impact on wellbeing.

CONCLUSIONS

Maintaining or increasing PA during COVID-19 lockdown was associated with better diabetes management, sleep, and wellbeing for children/adolescents with T1D, despite significant disruption to established routines. Use of technology during the pandemic contributed positively to wellbeing.

PRACTICE IMPLICATIONS

It is crucial to emphasize the significance of maintaining a well-structured routine when treating patients with type 1 diabetes. A consistent routine, incorporating regular physical exercise and good sleep hygiene, will help with managing overall diabetes control.

Assessment of clinical impact of SARS-CoV-2 in people with type 1 diabetes: A cohort study

OBJECTIVES

During the coronavirus 2019 pandemic, there had been more than 758 million COVID-19 cases as of February 13, 2023, and it is the main cause of death in many countries. Due to the variation in disease presentation, scientists determined that people living with type 2 diabetes mellitus were at higher risk of mortality. However, people living with type 1 diabetes have not been thoroughly studied, especially in extreme regions of developing countries. The objective of this study was to analyze the effects of SARS-CoV-2 pandemic restrictions on different variables in a cohort with type 1 diabetes.

METHODS

This cohort-type study included pediatric and adult patients with type 1 diabetes at Regional Hospital Dr. Juan Noé Crevani in Arica, Chile. Biosocial and anthropometric factors, clinical history, self-care activities, and biochemical parameters were assessed and compared using analysis of variance and paired t tests between March 2020 and March 2021.

RESULTS

A total of 150 patients were assessed during the SARS-CoV-2 pandemic in Arica, Chile. One year after the pandemic struck, the main causes for metabolic deterioration were a reduction of carbohydrate counting by an average of 8.67% (P = 0.000), a reduction of adherence to treatment by an average of 25% (P = 0.000), and a shift to telemedicine as a main health care service (P = 0.023); these factors raised hemoglobin A1c (HbA1c) levels by 1.81%, 1.78% and 0.075%, respectively. The participants' average body mass index (BMI) increased by 1.26 kg/m2 and HbA1c levels increased by 0.16% during the first year of the pandemic. Also, hospitalizations increased about 2% (P = 0.984), and there was a significant increase in carbohydrate and snack intake (P = 0.330 and P = 0.811, respectively). Children's linear growth decreased by a standard deviation of 0.035 (P = 0.648), and their physical activity decreased by 12.67% (P = 0.383).

CONCLUSIONS

This study found that adherence to diabetes care was reduced during the pandemic owing to a variety of behavioral reasons and environmental changes (e.g., quarantines and food security). This affected this population's HbA1c levels, BMI, linear growth, and number of hospitalizations as main consequences. Telemedicine remains an important tool, but it must be reconsidered among all different age groups.

"Does Physical Exercise Promote Health Benefits for Diabetic Patients during the COVID-19 Pandemic?": A Systematic Review

Patients affected by COVID-19 are prone to facing disorders in multiple systems and organs, which can lead to deleterious diseases; in addition, people with pre-existing diseases may be more prone to the worst outcomes, and the most vulnerable are patients with type 1 and type 2 diabetes mellitus. The aim of this systematic review was to evaluate the effects of physical activity and/or physical exercise prescribed to individuals with diabetes on the maintenance of plasma glucose and glycated hemoglobin during the COVID-19 pandemic. Studies were found by searching PubMed, SCOPUS, Embase, Web of Science, SciELO, LILACS, SportDiscus, Bireme/BVS and Google Scholar databases. The inclusion criteria were articles that addressed only patients with type 1 or type 2 diabetes (T1D and T2D) who had evaluated the level of physical activity or physical exercise and described the effects on plasma glucose and/or glycated hemoglobin in cross-sectional, retrospective, and observational studies, meeting the main criteria established by GRADE. The PICO and GRADE strategies were used to select and assess the methodological quality of studies. Two reviewers searched and selected the articles in databases independently and blindly, during which oppositions and disagreements about the inclusion of articles were discussed and resolved by a third reviewer. Evidence corroborates that levels of physical activity were reduced due to the lockdown, leading to increased body weight and worse glycemic control. On the other hand, individuals with diabetes mellitus (DM) (T1D and T2D) who maintained and/or increased levels of physical activity or physical exercise showed reduced plasma glucose and glycated hemoglobin (HbA1c) levels. Adequate levels of physical exercise and physical activity are beneficial for glucose and HbA1c control in diabetic patients (type 1 or type 2). In addition, maintaining adequate levels of physical activity can contribute to reducing health problems when these patients are infected with COVID-19.

Impacts of the COVID-19 Pandemic on Pediatric Type 1 Diabetes Management: A Qualitative Study

Purpose:

The purpose of this study was to understand impacts of the coronavirus (COVID-19) pandemic on pediatric type 1 diabetes management.

Methods:

In-depth qualitative interviews were conducted with 15 parents of children (age 6-12 years) with type 1 diabetes. Parents responded to 8 open-ended questions about their experiences managing their children’s type 1 diabetes during the COVID-19 pandemic. All interviews were transcribed, coded, and analyzed using qualitative thematic methods.

Results:

Parents reported both positive and negative aspects of managing their children’s type 1 diabetes during the COVID-19 pandemic. Facilitators of diabetes management included spending more time together at home and enhanced convenience of telehealth appointments and online supply ordering. Parents also described difficulties managing their children’s type 1 diabetes during the COVID-19 pandemic, including a lack of structure in their child’s daily routine, which led to increases in sedentary behavior. Furthermore, they reported psychosocial challenges of type 1 diabetes management, which were exacerbated by the pandemic.

Conclusion:

While the COVID-19 pandemic was described as having overall positive impacts on pediatric type 1 diabetes management, efforts to support parents in increasing children’s physical activity and reducing screen time are needed, along with readily accessible mental health resources for both parents and their children with type 1 diabetes.

The impact of the COVID-19 pandemic on glycaemic control in people with diabetes: A systematic review and meta-analysis

AIM

To identify, appraise and synthesize the available evidence on the impact of the coronavirus disease 2019 (COVID-19) pandemic and lockdown (LD) on glycaemic control in people with diabetes.

MATERIALS AND METHODS

We searched multiple databases up to 2 February 2021 for studies reporting HbA1c, time in range (TIR), average or fasting glucose, severe hypoglycaemia and diabetic ketoacidosis. Data were pooled using random effects meta-analysis and are presented as mean difference (MD) with 95% confidence intervals (CI). This review was preregistered on PROSPERO (CRD42020179319).

RESULTS

We include 59 studies; 44 (n = 15 464) were included in quantitative syntheses and 15 were narratively synthesized. Pooled data were grouped by diabetes type. Results from 28 studies (n = 5048 type 1 diabetes [T1D] and combined diabetes participants) showed that TIR increased during LD compared with before LD (MD 2.74%, 95% CI 1.80% to 3.69%). Data from 10 studies (n = 1294 T1D participants) showed that TIR increased after LD compared with before LD (MD 5.14%, 95% CI 3.12% to 7.16%). Pooled results from 12 studies (n = 4810 T1D and type 2 diabetes participants) resulted in average glucose decreasing after LD compared with before LD (MD -6.86 mg/dl, 95% CI -8.54 to -5.18). Results for other outcomes, including HbA1c, were not statistically significantly different.

CONCLUSIONS

The COVID-19 pandemic was associated with small improvements across multiple outcomes of glycaemic control, although there was insufficient evidence to suggest that this led to changes in HbA1c. Most evidence came from people with access to diabetes technologies in high-income countries; more research is needed in less advantaged populations.

Exploring Barriers and Facilitators to Physical Activity during the COVID-19 Pandemic: A Qualitative Study

Quantitative data show that physical activity (PA) reduced during the COVID-19 pandemic, with differential impacts across demographic groups. Qualitative research is limited; thus, this study aimed to understand barriers and facilitators to PA during the pandemic, focusing on groups more likely to have been affected by restrictions, and to map these onto the capability, opportunity, motivation model of behaviour (COM-B). One-to-one interviews were conducted with younger (aged 18–24) and older adults (aged 70+), those with long-term physical or mental health conditions, and parents of young children. Themes were identified using reflexive thematic analysis and were mapped onto COM-B domains. A total of 116 participants contributed (aged 18–93, 61% female, 71% White British). Key themes were the importance of the outdoor environment, impact of COVID-19 restrictions, fear of contracting COVID-19, and level of engagement with home exercise. Caring responsibilities and conflicting priorities were a barrier. PA as a method of socialising, establishing new routines, and the importance of PA for protecting mental health were motivators. Most themes mapped onto the physical opportunity (environmental factors) and reflective motivation (evaluations/plans) COM-B domains. Future interventions should target these domains during pandemics (e.g., adapting PA guidance depending on location and giving education on the health benefits of PA).

Physical Activity Behavior During and After COVID-19 Stay-at-Home Orders-A Longitudinal Study in the Austrian, German, and Italian Alps

Background

In Alpine regions, which are very similar due to their topographical location and their wide-ranging sports offerings, the restrictions on sports activities during the COVID-19 pandemic differed in type and level: while in some regions (Tyrol, South Tyrol, Trentino), all sports activities were forbidden except for walking near the home, in other regions (Upper Bavaria, Vorarlberg), people were allowed to go hiking and running during the first lockdown.

Objective

The aim of this study was to investigate the change in physical activity (PA) behavior in different Alpine regions (Upper Bavaria, Vorarlberg, Tyrol, South Tyrol, Trentino) over four periods in 2020, to examine the effects of COVID-19 measures of varying severity on PA behavior and to identify factors associated with a change in PA over time.

Methods

A retrospective online survey was conducted (N = 2975) from December 2020, to January 2021. Using the questionnaire of the Eurobarometer 472 study, PA behavior was measured over four periods: before COVID-19 (March), during the first lockdown (March and April), during the relaxed period (May-October) and during the second lockdown (November and December) in 2020.

Results

During the first (M = 5.0h, SD = 4.5) and the second lockdowns (M = 4.9h, SD = 4.3), the participants (age: 42 years, overly active in sports) engaged less in sports than before (M = 5.9h, SD = 4.8) and during the relaxed period in summer (M = 6.4h, SD = 5.0) (average number of hours per week being physically active). A larger percentage of participants from Alpine regions with severe restrictions (Tyrol, South Tyrol, Trentino) decreased their PA during the first lockdown as compared to participants from Upper Bavaria and Vorarlberg with a less strict first lockdown. Those with psychological distress, male participants, and individuals with decreased physical health and less free time during COVID-19 were more likely to reduce their PA.

Conclusions

Despite a short-term negative effect of COVID-19 restrictions on exercise participation during lockdowns, the majority of respondents returned to their original levels of PA during the relaxed COVID-19 phases. As a comparison of Alpine regions shows, particularly severe COVID-19 measures seem to have reduced PA with potential negative health effects. For the future, policy makers and sports organizations should collaborate to support the population in their PA behavior during pandemics to outweigh restrictions.

Effects of the lockdown period on the mental health of elite athletes during the COVID-19 pandemic: a narrative review

Purpose

This review aimed to assess the effects of COVID-19 pandemic lockdown on mental health to elite athletes. The emotional background influenced their sport career and was examined by questionnaires.

Methods

We included original studies that investigated psychological outcomes in elite athletes during COVID-19 lockdown. Sixteen original studies (n = 4475 participants) were analyzed.

Results

The findings showed that COVID-19 has an impact on elite athletes’ mental health and was linked with stress, anxiety and psychological distress. The magnitude of the impact was associated with athletes’ mood state profile, personality and resilience capacity.

Conclusion

The lockdown period impacted also elite athletes’ mental health and training routines with augmented anxiety but with fewer consequences than the general population thanks to adequate emotion regulation and coping strategies.

Impact of COVID-19 on physical activity: A rapid review

Background

Physical activity is a commonly prescribed medicine for people with conditions such as obesity and diabetes who are also at increased risk of being hospitalized or severely ill from COVID-19. However, many people are reporting challenges in engaging in a healthy dose of physical activity amid the pandemic.

Objective

This rapid review synthesizes the current empirical evidence about the impacts of COVID-19 on people’s outdoor physical activity and sedentary behavior while highlighting the role of community environments in promoting or hindering physical activity during the pandemic.

Methods

Literature searches were conducted using keywords related to COVID-19: physical activity, mobility, and lifestyle behaviors. Eligibility criteria were peer-reviewed empirical and quantitative studies published in English, addressing COVID-19 and using physical activity and/or sedentary behavior as the study outcomes.

Results

Out of 61 eligible studies, the majority (78.3%) were conducted in Asian and European countries, with only four (6.7%) being US studies. The results showed that COVID-19 was linked with significant decreases in mobility, walking, and physical activity, and increases in sedentary activity. A few studies also reported contradicting results including increased uses of parks/trails and increased recreational activity among certain groups of population.

Conclusions

Evidence suggests an overall negative impact of COVID-19 on physical activity, with differential effects across different sub-populations. Significant knowledge gaps are also found in the roles of social and physical attributes that can promote physical activity during pandemics with reduced safety risks.

The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review

Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders.

Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found.

Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future.

Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.

Clinical Team Response to the Impact of COVID-19 on Diabetes Self-Management: Findings From a Qualitative Study

The aims of this study were to explore providers’ perceptions of how COVID-19 affected patients’ psychological wellbeing and diabetes self-care and discover how providers responded to sustain and improve patients’ psychological health and diabetes management during the pandemic. Twenty-four semi-structured interviews were completed with primary care providers (n=14) and endocrine specialty clinicians (n=10) across sixteen clinics in North Carolina. Interview topics included: (1) current glucose monitoring approaches and diabetes management strategies for people with diabetes (2) barriers and unintended consequences encountered with respect to diabetes self-management, and (3) innovative strategies developed to overcome barriers. Interview transcripts were coded using qualitative analysis software and analyzed to identify cross-cutting themes and differences between participants. Primary care providers and endocrine specialty clinicians reported that people with diabetes experienced increased mental health symptoms, increased financial challenges and positive and negative changes in self-care routines due to COVID-19. To offer support, primary care providers and endocrine specialty providers focused discussions on lifestyle management and utilized telemedicine to connect with patients. Additionally, endocrine specialty clinicians helped patients access financial assistance programs. Findings indicate that people with diabetes experienced unique challenges to self-management during the pandemic and providers responded with targeted support strategies. Future research should explore the effectiveness of these provider interventions as the pandemic continues to evolve.

Integrated Nutritional Supports for Diabetic Patients During COVID-19 Infection: A Comprehensive Review

BACKGROUND

Diabetes mellitus is an endocrine metabolic disorder, which affects the major organs in human and comorbid with others. Besides, diabetic patients are more prone to various infectious diseases as well as COVID-19 sporadic infection which is a high risk for patients with diabetes mellitus. To combat these infections and comorbid situations, an integrated balanced nutritional supportive could help in maintaining sound health and increase immunity for prevention and management of such type of viral infections.

OBJECTIVES

While information regarding nutritional supports in COVID-19 pandemic in diabetic patients is not available, this review aimed to accumulate the evidence from previous publications where studied about nutrition-based supports or interventions for viral diseases with special emphasis on respiratory infections.

METHODS

For reviewing, searches are done for getting journal articles into Google Scholar, Pub Med/Medline, Database of Open Access Journal and Science Direct for relevant data and information.

RESULTS

Integrated nutritional supports of both macronutrients and micronutrients guidelines, including home-based physical exercise schedule, is summarized in this comprehensive review for possible prevention and management of diabetic patients in COVID-19 infections. The immuneboosting benefits of some vitamins, trace elements, nutraceuticals and probiotics in viral infections of diabetic patients are also included.

CONCLUSION

There is an urgent need for a healthy diet and integrated nutritional supports with home-based physical activities for diabetic patients during the self-isolation period of COVID-19 Infection.

Social Distancing, Physical Activity, and COVID-19: Implications for Type 1 Diabetes Mellitus in Brazil

A lack of glycemic control and diabetes are risk factors for complications related to COVID-19, and social isolation can hinder adherence to physical activity. Thus, this study sought to assess the impacts of social distancing on the practice of physical activity of individuals with type 1 diabetes mellitus (T1DM). This was a transversal study carried out using an online form to collect sociodemographic, practice of physical activity, and social distancing data. Of the 472 participants, 85.6% reported that they were respecting the steps of social distancing. Social distancing affected the practice of physical activity in adherence to the habit of practicing in frequency, duration, and perception of change in intensity. An association was found between noticing a lot of stress in the home environment and stopping physical activity; lower levels of tolerance to social distancing were associated with less physical activity, and maintaining the habit of practicing physical activity was associated with decreasing the intensity of the practice. Hence, social distancing harmed the practice of physical activity as part of the treatment of individuals with T1DM, both in the habit of practicing and in the characteristics of these practices of physical activity, such as frequency, duration, and intensity.

Glucose control in diabetes during home confinement for the first pandemic wave of COVID-19: a meta-analysis of observational studies

AIM

To assess the effect on glycaemic control of confinement due to lockdown measures, during COVID-19 pandemic, in people with type 1 (T1DM) and type 2 (T2DM) diabetes.

METHODS

Meta-analysis of observational studies reporting measures of glucose control and variability before and during and/or after periods of confinement caused by COVID-19 in 2020 and/or 2021.

RESULTS

We included 27 studies on T1DM. No significant change in Hba1c was observed after lockdown (WMD - 1.474 [- 3.26; 0.31] mmol/mol, I² = 93.9). TIR significantly increased during and after lockdown (WMD: 2.73 1.47; 4.23 %, I² = 81% and 3.73 [1.13; 5.33] %, I² = 85%, respectively).We retrieved nine studies on T2DM patients. No significant variation in HbA1c was detected (WMD - 1.257 - 3.91; 1.39 mmol/mol, I² = 98.3%). HbA1c had a more favourable trend in studies performed in Asia than in Europe (p = 0.022 between groups).

CONCLUSION

Lockdown showed no significant detrimental effect on HbA1c in either T1DM or T2DM. Conversely, home confinement led to a reduction in mean glucose and glucose variability in T1DM, although with a high heterogeneity of results.

Self-isolation negatively impacts self-management of diabetes during the coronavirus (COVID-19) pandemic

BACKGROUND/AIM

People with diabetes are at a greater risk of serious complications from Coronavirus disease (COVID-19). Self-management of diabetes is therefore of paramount importance. The purpose of this study is to compare self-management of diabetes pre-COVID-19 and during the COVID-19 pandemic.

METHODS

679 participants with diabetes completed an online structured questionnaire survey. Various exposure variables (demographics, duration, treatment and complications of diabetes, self-isolation, etc.) were analysed to examine associations with the following outcome variables: (i) fluctuation of blood glucose levels, (ii) access to diabetes medicine, (iii) access to healthy diet, (iv) physical activity. Adjusted multiple regression analysis ascertained significant associations for each outcome variable against exposure variables.

RESULTS

Multiple regression analysis showed that self-isolation was significantly associated with greater fluctuation in blood glucose levels (OR = 1.8, 95% CI = 1.2-2.6, p = 0.005), reduced access to diabetes medicine (OR = 1.9, 95% CI = 1.1-3.1, p = 0.02) and reduced access to healthy diet (OR = 3.0, 95% CI = 2.0-4.6, p < 0.001). Fluctuation in blood glucose level was also significantly associated with having at least one complication of diabetes (OR = 2.2, 95% CI = 1.2-3.9, p = 0.008) and reduced access to diabetes medicine was significantly higher in people who were on insulin (OR = 2.1, 95% CI = 1.3-3.3, p = 0.001).

CONCLUSIONS

Self-isolation was shown to impact almost all factors that influence self-management of diabetes. A targeted approach to improved access to diabetes medicine, healthy diet for people who needed to self-isolate is vital in order to ensure that they are able to self-manage their diabetes effectively.

Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies

AIMS

To assess the effects of lockdown due to COVID-19 pandemic on glucose metrics, measured by glucose monitoring systems, in adult individuals with type 1 diabetes.

METHODS

We conducted a systematic literature search for English language articles from MEDLINE, Scopus and Web of Science up to February 28, 2021, using "diabetes", "lockdown", and "glucose" as key search terms. Time in range (TIR) was the main outcome; other metrics were time above range (TAR), time below range (TBR), mean blood glucose (MBG) and its variability (%CV), estimated HbA1c (eA1c) or glucose management indicator (GMI).

RESULTS

Seventeen studies for a total of 3,441 individuals with type 1 diabetes were included in the analysis. In the lockdown period, TIR 70-180 mg/dl increased by 3.05% (95% CI 1.67-4.43%; p < 0.0001) while TAR (>180 mg/dL and > 250 mg/dL) declined by 3.39% (-5.14 to -1.63%) and 1.96% (-2.51 to -1.42%), respectively (p < 0.0001 for both). Both TBR < 70 and <54 mg/dL remained unchanged. MBG slightly decreased by 5.40 mg/dL (-7.29 to -3.51 mg/dL; p < 0.0001) along with a reduction in %CV. Pooled eA1c and GMI decreased by 0.18% (-0.24 to -0.11%; p < 0.0001) and a similar reduction was observed when GMI alone was considered (0.15%, -0.23 to -0.07%; p < 0.0001). Sensor use was only slightly but not significantly reduced during lockdown.

CONCLUSIONS

This meta-analysis shows that well-controlled people with type 1 diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters.

COVID-19 and Type 1 Diabetes: Addressing Concerns and Maintaining Control

The worldwide outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been an unprecedented pandemic. Early on, even as the signs and symptoms of coronavirus disease 2019 (COVID-19) were first characterized, significant concerns were articulated regarding its potential impact on people with chronic disease, including type 1 diabetes. Information about the basic and clinical interrelationships between COVID-19 and diabetes has rapidly emerged. Initial rapid reports were useful to provide alerts and guide health care responses and initial policies. Some of these have proven subsequently to have durable findings, whereas others lacked scientific rigor/reproducibility. Many publications that report on COVID-19 and "diabetes" also have not distinguished between type 1 and type 2 (1). Available evidence now demonstrates that people with type 1 diabetes have been acutely affected by COVID-19 in multiple ways. This includes effects from limited access to health care, particularly during lockdown periods, and increased morbidity/mortality in infected adults with type 1 diabetes compared with peers without diabetes.

Impact of COVID-19 and partial lockdown on access to care, self-management and psychological well-being among people with diabetes: A cross-sectional study

BACKGROUND

The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, self-care, behavioural, and psychological impact of COVID-19 and partial lockdown amongst diabetes patients in Singapore.

METHODS

We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models.

RESULTS

Among 301 respondents, 45.2% were women, 67.1% of Chinese ethnicity, 24.2% were aged 40 to 49 years, 68.4% have Type 2 diabetes and 42.2% on oral medications alone. During the pandemic and the lockdown, nearly all respondents were able to receive care safely from the clinics they attend (94%) and obtain their medications and diabetes equipment and supplies (97%) when needed. Respondents reported less frequent engagement in physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (β = 9.33, P = .043), Type 1 diabetes (β = 12.92, P = .023), number of diabetes-related comorbidities (β = 3.16, P = .007) and Indian ethnicity (β = 6.65, P = .034) were associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (β = 2.49, P = .014) while ability to reach their doctor despite not going to the clinic is negatively associated with psychological distress (β = -9.50 P = .002) and barriers to activity (β = -7.53, P = .007).

CONCLUSION

Health services access were minimally affected, but COVID-19 and lockdown had mixed impacts on self-care and management behaviours. Greater clinical care and attention should be provided to people with diabetes with multiple comorbidities and previous mental health disorders during the pandemic and lockdown.

"CoVidentary": An online exercise training program to reduce sedentary behaviours in children with type 1 diabetes during the COVID-19 pandemic

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Covid-19 restrictions disrupted physical activities in children with type 1 diabetes.

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Diabetes management worsened in glycemia values and insulin delivery.

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Active breaks rather than structured training may interrupt sedentary in children with type 1 diabetes.

Aim

We explored the physical activity (PA) level and the variation in glycaemic control in children with type 1 diabetes (T1D) before and during the lockdown. Then, we proposed an online training program supported by sport-science specialists.

Methods

Parents of children with T1D (<18 years) filled out an online survey. Anthropometric characteristics, PA, play, sport and sedentary time and the medical related outcomes were recorded. An adapted online program “Covidentary” was proposed through full-training (FT) and active breaks (AB) modality.

Results

280 youth (11.8 ± 3.3 years) were included in the analysis. We reported a decline in sport (-2.1 ± 2.1 h/week) and outdoor-plays (-73.9 ± 93.6 min/day). Moreover, we found an increase in sedentary time (+144.7 ± 147.8 min/day), in mean glycaemic values (+25.4 ± 33.4 mg/dL) and insulin delivery (71.8% of patients). 37% of invited patients attended the training program, 46% took part in AB and 54% in FT. The AB was carried out for 90% of the total duration, while the FT for 31%. Both types of training were perceived as moderate intensity effort.

Conclusion

A decline of participation in sport activities and a subsequent increase of sedentary time influence the management of T1D of children, increasing the risk of acute/long-term complications. Online exercise program may contrast the pandemic's sedentary lifestyle.

The Impact of a Culinary Coaching Telemedicine Program on Home Cooking and Emotional Well-Being during the COVID-19 Pandemic

The coronavirus pandemic enforced social restrictions with abrupt impacts on mental health and changes to health behaviors. From a randomized clinical trial, we assessed the impact of culinary education on home cooking practices, coping strategies and resiliency during the first wave of the COVID-19 pandemic (March/April 2020). Participants (n = 28) were aged 25–70 years with a BMI of 27.5–35 kg/m². The intervention consisted of 12 weekly 30-min one-on-one telemedicine culinary coaching sessions. Coping strategies were assessed through the Brief Coping with Problems Experienced Inventory, and resiliency using the Brief Resilient Coping Scale. Home cooking practices were assessed through qualitative analysis. The average use of self-care as a coping strategy by the intervention group was 6.14 (1.66), compared to the control with 4.64 (1.69); p = 0.03. While more intervention participants had high (n = 5) and medium (n = 8) resiliency compared to controls (n = 4, n = 6, respectively), this difference was not significant (p = 0.33). Intervention participants reported using home cooking skills such as meal planning and time saving techniques during the pandemic. The key findings were that culinary coaching via telemedicine may be an effective intervention for teaching home cooking skills and promoting the use of self-care as a coping strategy during times of stress, including the COVID-19 pandemic.

Physical Activity during COVID-19 Lockdown in Italy: A Systematic Review

The recent COVID-19 pandemic has imposed a general lockdown in Italy, one of the most affected countries at the beginning of the outbreak, between 9 March and 3 May 2020. As a consequence, Italian citizens were confined at home for almost two months, an unprecedented situation, which could have negative effects on both psychological and physical health. The aim of this study was to review the published papers concerning the effects of the lockdown on physical activity and the consequences on general health. As expected, most studies highlighted a significant reduction in the amount of performed physical activity compared to before lockdown, in both the general population and in individuals with chronic conditions. This fact had negative consequences on both general health, in terms of increased body mass, and on specific chronic conditions, especially obesity and neurological diseases.

Physical Activity, Sedentary Behavior and Well-Being of Adults with Physical Disabilities and/or Chronic Diseases during the First Wave of the COVID-19 Pandemic: A Rapid Review

Background: People with physical disabilities and/or chronic diseases report lower levels of physical activity and well-being than the general population, which potentially is exacerbated through the COVID-19 pandemic. This study explored the international literature on physical activity, sedentary behavior and well-being in adults with physical disabilities and/or chronic diseases during the first wave of the pandemic. Method: In a rapid review, we included studies reporting on physical activity, sedentary behavior and/or well-being in adults with physical disabilities and/or chronic diseases. Four databases (Pubmed, CINAHL, PsycInfo, Embase) were searched for studies published until 30 September 2020. Results: We included twenty-nine studies involving eleven different types of disabilities or health conditions from twenty-one different countries. Twenty-six studies reported on physical activity, of which one reported an increase during the COVID-19 pandemic, four studies reported no difference, and twenty-one studies reported a decrease. Thirteen studies reported a decline in well-being. Only one study measured sedentary behavior, reporting an increase. Conclusion: Despite the variety in methods used, almost all studies reported negative impacts on physical activity and well-being in people with physical disabilities and/or chronic disease during the first wave of the pandemic. These findings highlight the importance of supporting this population, especially in times of crisis.

Physical Activity in Adolescents with and without Type 1 Diabetes during the New Zealand COVID-19 Pandemic Lockdown of 2020

Physical activity (PA) is an important part of lifestyle management for adolescents with Type 1 diabetes (T1D). Opportunities for PA were reduced by COVID-19 restrictions. Therefore, the purpose of this cross-sectional study was to compare PA among adolescents with and without T1D during the first New Zealand (NZ) COVID-19 lockdown. PA levels of adolescents aged 11-18 years with T1D (n = 33) and healthy controls (n = 34) were assessed through self-reported and parent proxy-reported questionnaires. Overall, PA levels during lockdown were below recommended levels. PA levels did not differ between T1D and control participants (p = 0.212) nor between genders (p = 0.149). Younger adolescents tended to be more active than older adolescents (p = 0.079). PA level was negatively associated with BMI z-score (r = -0.29, p = 0.026) but was not associated with socioeconomic status (SES) or T1D-related parameters. In the T1D group, higher HbA1c was associated with lower school decile (r = -0.58, p < 0.001) and higher BMI z-score (r = 0.68, p < 0.001). Overall, young people were insufficiently active during lockdown, and some sub-groups were more affected than others by the restrictions. Pandemics are likely to be part of our future, and further studies are needed to understand their impact on the health and wellbeing of adolescents.

The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review

BACKGROUND

Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions.

METHODS

A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021.

FINDINGS

During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed.

INTERPRETATION

Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.

Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review

OBJECTIVE

In March 2020, several countries banned unnecessary outdoor activities during COVID-19, commonly called 'lockdowns. These lockdowns have the potential to impact associated levels of physical activity and sedentary behaviour. Given the numerous health outcomes associated with physical activity and sedentary behaviour, the aim of this review was to summarise literature that investigated differences in physical activity and sedentary behaviour before vs during the COVID-19 lockdown.

DESIGN DATA SOURCES AND ELIGIBILITY CRITERIA

Electronic databases were searched from November 2019 to October 2020 using terms and synonyms relating to physical activity, sedentary behaviour and COVID-19. The coprimary outcomes were changes in physical activity and/or sedentary behaviour captured via device-based measures or self-report tools. Risk of bias was measured using the Newcastle-Ottawa Scale.

RESULTS

Sixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions.

CONCLUSION

Given the numerous physical and mental benefits of increased physical activity and decreased sedentary behaviour, public health strategies should include the creation and implementation of interventions that promote safe physical activity and reduce sedentary behaviour should other lockdowns occur.

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

Initial studies found increased severity of coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients with diabetes mellitus. Furthermore, COVID-19 might also predispose infected individuals to hyperglycaemia. Interacting with other risk factors, hyperglycaemia might modulate immune and inflammatory responses, thus predisposing patients to severe COVID-19 and possible lethal outcomes. Angiotensin-converting enzyme 2 (ACE2), which is part of the renin-angiotensin-aldosterone system (RAAS), is the main entry receptor for SARS-CoV-2; although dipeptidyl peptidase 4 (DPP4) might also act as a binding target. Preliminary data, however, do not suggest a notable effect of glucose-lowering DPP4 inhibitors on SARS-CoV-2 susceptibility. Owing to their pharmacological characteristics, sodium-glucose cotransporter 2 (SGLT2) inhibitors might cause adverse effects in patients with COVID-19 and so cannot be recommended. Currently, insulin should be the main approach to the control of acute glycaemia. Most available evidence does not distinguish between the major types of diabetes mellitus and is related to type 2 diabetes mellitus owing to its high prevalence. However, some limited evidence is now available on type 1 diabetes mellitus and COVID-19. Most of these conclusions are preliminary, and further investigation of the optimal management in patients with diabetes mellitus is warranted.

Cooking habits and food choices of individuals with Type 1 Diabetes Mellitus during the pandemic of COVID-19

ABSTRACT Objective To verify the association between cooking habits, socioeconomic data, and food choices of individuals with Type 1 Diabetes Mellitus during the pandemic of COVID-19. Methods Transversal study with individuals with Type 1 Diabetes Mellitus carried out in July 2020. Socioeconomic data and information about social distancing and food practices were collected with an online form. The research was approved by the university’s Ethics and Research Committee (Process number 4.147.663). Results Out of the 472 participants, 50.9% reported that they have been cooking more during the pandemic. An association between cooking more and having a university degree (p<0.000) was observed. Not being able to comply with social distancing rules because of work necessities was associated with not cooking (p=0.006). Cooking more during the quarantine was associated with eating less than five meals per day (p=0.04), having an appropriate consumption of fruits (p=0.02) and vegetables (p=0.04), and increased water intake (p=0.01). Conclusion In Brazil, the habit of cooking during the pandemic may represent an increase in domestic work, reinforced by social inequalities. Therefore, comprehending the cooking habits and food choices of people with diabetes may widen the perspectives of health professionals involved in the treatment of the disease and contribute to the elaboration of public policies that take the country's inequalities into account. We emphasize the importance of investing in policies that encourage the development of culinary skills, as well as the habit of cooking as part of the actions of Food and Nutrition Education.

Physical activity levels across COVID-19 outbreak in youngsters of Northwestern Lombardy

BACKGROUND

Italy early experienced one of the most suffering impact of the COVID-19 outbreak in terms of number of cases and death toll. Progressively, more compelling national restrictions hardened citizens' lifestyle and habits, including limiting mobility and outdoor physical activity (PA). In a second phase, people were allowed to perform outdoor activities close to their houses and thereafter motor or sports activity were gradually reintroduced. These drastic changes raised the question on how to cope and exploit the residual opportunities of PA under circumstances of home confinement.

METHODS

International Physical Activity Questionnaires were administered to 1568 youngsters from North-western Italian high schools, before, during, and after lockdown enacted by Italian Government to contrast the COVID-19 pandemic.

RESULTS

Student's PA levels were significantly different before (1676.37±20.6 MET-min/week) and after (1774.50±33.93 MET-min/week) the governmental restrictions (TIME effect: F=3.49; η<inf>p</inf>²⁼0.005 P=0.03). There was a significant TIME*CATEGORY interaction effect (F=8.37; η<inf>p</inf>²⁼0.021; P<0.001). In particular, only highly active students (>2520 MET-min/week) increased their PA during (3467.48±55.85 MET-min/week) and after (3515.73±65.75 MET-min/week) the lockdown measures with respect to their baseline levels (3151.43±42.41 MET-min/week).

CONCLUSIONS

Lockdown measures, including isolation, impacted negatively on the PA levels of the already inactive or moderately active young population. Government actions should enhance strategies to control physical inactivity during pandemics like COVID-19.

Studies of Physical Activity and COVID-19 During the Pandemic: A Scoping Review

BACKGROUND

This scoping review aimed to identify the available evidence related to physical activity (PA) and the coronavirus disease (COVID-19) pandemic.

METHODS

A search in 6 databases (PubMed, Embase, SPORTDiscus, Scopus, Web of Science, and CINAHL) was conducted on July 23, 2020. Medical subject headings and keywords related to PA and COVID-19 were combined to conduct the online search, which covered the period from January to July 2020.

RESULTS

Overall, 1784 articles were retrieved. After duplicate removal and title, abstract, and full-text screening, 41 articles were included. Most of the included studies were quantitative and collected data through online interviews/questionnaires, with sample sizes larger than 100 and composed by adults and older adults. Changes in PA levels due to the COVID-19 pandemic were the most assessed outcome, followed by the association between mental health issues and PA. Only 2 studies assessed the direct effects of PA on COVID-19.

CONCLUSION

Most of the evidence identified a decrease in PA levels due to social distancing measures and that PA might help to decrease the mental health burden related to the COVID-19 outbreak.

Clinical characteristics of hospitalized and home isolated COVID-19 patients with type 1 diabetes

BACKGROUND AND AIMS

To elucidate the clinical features of COVID-19 patients with type 1 diabetes (T1D) under hospitalization and home isolation conditions.

METHOD

This retrospective study was conducted among 32 patients with COVID-19 and T1D, who sought treatment at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia between May 01, 2020 and July 30, 2020. Patients data were extracted from electronic medical records.

RESULTS

Of the total of 32 COVID-19 patients with T1D, 21.9% required hospitalization, while 78.1% underwent home isolation. Among the study population, 9.4% (3/32) were reported to have hypertension, 21.9% (7/32) had chronic pulmonary disease (CPD), 18.8% (6/32) had thyroid disorders, and 18.8% (6/32) had the celiac disease. Of the 32 studied patients, 68.8% (22/32) of them were reported as normal, while 28.1% (9/32) had chronic kidney disease (CKD) II and 3.1% (1/32) had end-stage renal failure. The most common symptoms observed among the hospitalized patients were nausea and vomiting (71.4%; 5/7), followed by fever (57.1%; 4/7), cough (42.8%; 3/7), sore throat (42.8%; 3/7), abdominal pain (42.8%; 3/7) and dyspnea (42.%; 3/7). The most common reasons for hospitalization were diabetic ketoacidosis (71.4%; 5/7) followed by bacterial pneumonia (14.3%; 1/7), fever (14.3%; 1/7), sore throat (14.3%; 1/7), severe hyperglycemia (14.3%; 1/7) and COVID-19 pneumonia (14.3%; 1/7). Except the severity of COVID-19 (p = 0.0001), none of the demographic and clinical parameters indicated statistically significant differences between patients requiring hospitalization and home isolation.

CONCLUSION

Majority of the COVID-19 patients with T1D recovered with conservative treatment at home. Diabetic ketoacidosis was the most common reason for hospitalization.

Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic

BACKGROUND/OBJECTIVE

To minimize the wide spread of coronavirus disease (COVID-19) pandemic, Italy was placed in an almost complete lockdown state that forced people to "stay at home". Aim of this study was to evaluate the effects of lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) followed through telemedicine.

SUBJECTS/METHODS

This observational study involved patients with T1D using the real-time continuous glucose monitoring (CGM) Dexcom G6^®. Ambulatory glucose profile data from the 3-months before schools closure (November 26, 2019-February 23, 2020; T0) and from the 3-months of consecutive lockdown (February 24-May 18, 2020; T1) were compared.

RESULTS

Sixty-two children and adolescents (11.1 ± 4.37 years, 50% males) with T1D (median time disease 3.67 years) were enrolled in the study. Insulin total daily dose was unchanged, while time spent on physical activities was decreased (p<0.0001). Despite the lack of statistical significance, median value of the glucose management indicator decreased from 7.4% to 7.25%. Glucose standard deviation (p<0.0001) and coefficient of variation (p=0.001) improved across the study. Median time in range increased from 60.5% to 63.5% (p=0.008), time above range decreased from 37.3% to 34.1% (p=0.048), and time below range decreased from 1.85% to 1.45% (p=0.001).

CONCLUSIONS

Overall, in our children and adolescents with T1D glycemic control improved during lockdown. Despite patients were confined to their homes and limited to exercise, our data suggest that the use of real-time CGM, the continuous parental management, and the telemedicine can display beneficial effects on T1D care.