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Auzanneau M, Kieninger DM, Laubner K, Renner C, Mirza J, Däublin G, Praedicow K, Haberland H, Steigleder-Schweiger C, Gohlke B, Galler A, Holl RW. Comparison of BMI and HbA1c changes before and during the COVID-19 pandemic in type 1 diabetes: a longitudinal population-based study. J Diabetes Metab Disord 2024; 23:573-583. [PMID: 38932874 PMCID: PMC11196535 DOI: 10.1007/s40200-023-01316-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/17/2023] [Indexed: 06/28/2024]
Abstract
Purpose To compare the changes in body weight and glycemic control before and during the COVID-19 pandemic in people with type 1 diabetes (T1D). Methods In 47,065 individuals with T1D from the German Diabetes Prospective Follow-up Registry (DPV), we compared the adjusted mean changes in BMI-Z-scores and HbA1c as well as the distribution of individual changes between four periods from March 2018 to February 2022, by sex and age group (4- < 11, 11- < 16, 16-50 years). Results At population level, the only significant pandemic effects were a slight increase in BMI Z-score in prepubertal children (girls: + 0.03 in the first COVID year vs. before, P < 0.01; boys: + 0.04, P < 0.01) as well as a stabilization of HbA1c in all subgroups or even improvement in women (- 0.08%, P < 0.01). At individual level, however, heterogeneity increased significantly (p < 0.01), especially in children. More prepubertal children gained weight (girls: 45% vs. 35% before COVID; boys: 39% vs. 33%). More pubertal girls lost weight (30% vs. 21%) and fewer gained weight (43% vs. 54%). More children had a decreasing HbA1c (prepubertal group: 29% vs. 22%; pubertal girls: 33% vs. 28%; pubertal boys: 32% vs. 25%) and fewer had increasing values. More women had stable HbA1c and fewer had increasing values (30% vs. 37%). In men, no significant changes were observed. Conclusion This real-world analysis shows no detrimental consequences of the two first COVID years on weight and HbA1c in T1D on average, but reveals, beyond the mean trends, a greater variability at the individual level.
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Affiliation(s)
- Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg Germany
| | - Dorothee M. Kieninger
- Diabetes Division, Department of Paediatrics, Universitätsmedizin Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Joaquina Mirza
- Kinderkrankenhaus Amsterdamer Straße, Paediatric Diabetology, Klinik Für Kinder- Und Jugendmedizin, Kliniken Köln, Cologne, Germany
| | | | - Kirsten Praedicow
- Clinic for Children and Adolescent Medicine, Diabetology and Endocrinology, Helios Clinical Centre Aue, Aue-Bad Schlema, Germany
| | - Holger Haberland
- Paediatric Diabetology, Klinik Für Kinder- Und Jugendmedizin, Sana Klinikum Lichtenberg, Berlin, Germany
| | | | - Bettina Gohlke
- Paediatric Endocrinology and Diabetology, University of Bonn, Bonn, Germany
| | - Angela Galler
- Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Und Humboldt-Universität Zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg Germany
| | - on behalf of the DPV Initiative
- Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg Germany
- Diabetes Division, Department of Paediatrics, Universitätsmedizin Johannes Gutenberg Universität Mainz, Mainz, Germany
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Pediatric Practice Deggendorf, Deggendorf, Germany
- Kinderkrankenhaus Amsterdamer Straße, Paediatric Diabetology, Klinik Für Kinder- Und Jugendmedizin, Kliniken Köln, Cologne, Germany
- Children’s Hospital Aurich, Aurich, Germany
- Clinic for Children and Adolescent Medicine, Diabetology and Endocrinology, Helios Clinical Centre Aue, Aue-Bad Schlema, Germany
- Paediatric Diabetology, Klinik Für Kinder- Und Jugendmedizin, Sana Klinikum Lichtenberg, Berlin, Germany
- Department of Paediatrics, Paracelsus Medical University, Salzburg, Austria
- Paediatric Endocrinology and Diabetology, University of Bonn, Bonn, Germany
- Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Und Humboldt-Universität Zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
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Tajdar D, Lühmann D, Walther L, Bittner L, Scherer M, Schäfer I. 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. Diabetes Ther 2024; 15:1375-1388. [PMID: 38642263 PMCID: PMC11096287 DOI: 10.1007/s13300-024-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/22/2024] [Indexed: 04/22/2024] Open
Abstract
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.
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Affiliation(s)
- Daniel Tajdar
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dagmar Lühmann
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Laura Walther
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Lasse Bittner
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Scherer
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ingmar Schäfer
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Parihar R, Rana S, Punthakee Z, Gerstein H, Braga M, Pigeyre M. Impact of COVID-19 Lockdown on Occurrence of Acute Complications of Type 1 and Type 2 Diabetes and Overall Glycemic Management. Can J Diabetes 2024; 48:120-124. [PMID: 38092244 DOI: 10.1016/j.jcjd.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/04/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES The association of diabetes, and COVID-19 infection has been studied extensively; however, the occurrence of diabetic ketoacidosis (DKA) or hyperglycemic/hyperosmolar states (HHS) in adults during the lockdown has not been well characterized. In this study, we aimed to identify the impact of the lockdown on occurrence and severity of DKA/HHS admissions and glycemic management. METHODS A retrospective chart review was conducted of patients admitted to Hamilton Health Sciences with a diagnosis of DKA or HHS from April to September 2019 (pre-lockdown) and from April to September 2020 (lockdown). Adult (≥18 years old) nonpregnant patients with a single admission in the study period were included for study. RESULTS There were 229 admissions related to diabetes, with 171 admissions meeting the inclusion criteria (n=92 pre-lockdown, n=79 lockdown). In the lockdown group, 51.8% of the patients had type 2 diabetes mellitus, with 96.2% of admissions secondary to DKA. When comparing the 2 periods, the lockdown group trended toward higher rates of death (5.4% vs 10.1%, p=0.247) and euglycemic DKA (17.6% vs 24.4%, p=0.403). There were more new diagnoses of type 1 diabetes mellitus in the lockdown group compared with the pre-lockdown group (7.3% vs 16.7%, p=0.230). The average glycated hemoglobin was lower in the lockdown group compared with the pre-lockdown group (11.8% vs 10.4%, p=0.032). CONCLUSIONS Overall, this study is among the first in Canada to assess the impact of the COVID-19 lockdown on admissions due to DKA and HHS. Although no significant differences were noted in severity of admissions, there was a trend toward more new diagnoses of type 1 diabetes mellitus presenting in DKA during the lockdown period.
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Affiliation(s)
- Richa Parihar
- Department of Medicine, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada.
| | - Simrit Rana
- Department of Medicine, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Zubin Punthakee
- Department of Medicine, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Hertzel Gerstein
- Department of Medicine, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Manoela Braga
- Department of Medicine, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Marie Pigeyre
- Department of Medicine, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
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Maksoud AAA, Salah NY, Ayoup SAA. Glycemic variability and time in range among children with type 1 diabetes on insulin pump during the Covid-19 pandemic in Egypt; single center experience. BMC Endocr Disord 2023; 23:262. [PMID: 38012643 PMCID: PMC10680322 DOI: 10.1186/s12902-023-01517-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Covid-19 has impacted the lives of individuals worldwide especially those with chronic illnesses. Children with type 1 diabetes (T1DM) are at risk of glycemic deterioration during the Covid-19 pandemic. However, some studies reported glycemic improvement in these children during the pandemic. AIM To assess the impact of Covid-19 on glycemic control and acute complications among children with T1DM on insulin pump in Egypt. METHODOLOGY Forty-two children with T1DM on insulin pump for at least 1 year were assessed during the period from June 2020 to May 2021 for insulin requirements, insulin-pump problems, frequency of diabetic-ketoacidosis (DKA), hypoglycemia and HbA1C. Continuous-glucose monitoring was done using Medtronic i-pro device for 5 days. Data were compared to those obtained from the patients' medical records 1 year previously. RESULT Upon comparing data during Covid-19 pandemic with previous data from 12-24 months before Covid-19, there was a significant small increase in the mean total daily insulin dose from 0.83 ± 0.28 to 0.88 ± 0.30 U/kg/day with a similar small increase in the mean basal percentage from 51.19 ± 3.46 to 52.74 ± 4.31. Interestingly, the median time in range showed small increase from 53 (IQR 47-61) to 57.0 (IQR 51-73), the mean coefficient of variation showed small decrease from 42.10 ± 9.90 to 38.20 ± 8.12 and the mean HbA1C significantly decreased from 8.8 ± 1.3 (72.31 ± 16.78 mmol/ml) to 7.8 ± 1.2 mg/dl (61.31 ± 16.62 mmol/mol). Twenty-nine children (69%) had insulin-pump problems in the form of skin irritation (31%), skin infection (7.1%) and pump Set/Site occlusion (31%). CONCLUSION No safety issues and overall glycemic improvement were reported among the children with T1DM on insulin pump therapy from this single center during the covid-19 pandemic.
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Affiliation(s)
- Abeer Ahmed Abdel Maksoud
- Pediatrics Department, Faculty of Medicine, Ain Shams University, 25 Korash Street, Nasr City, Cairo, Egypt
| | - Nouran Yousef Salah
- Pediatrics Department, Faculty of Medicine, Ain Shams University, 25 Korash Street, Nasr City, Cairo, Egypt.
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Sim R, Chong CW, Loganadan NK, Hussein Z, Adam NL, Lee SWH. Impact of COVID-19 Lockdown on Glycemic, Weight, Blood Pressure Control and Medication Adherence in Patients with Type 2 Diabetes. Patient Prefer Adherence 2023; 17:2109-2117. [PMID: 37644964 PMCID: PMC10461747 DOI: 10.2147/ppa.s420545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
Medication adherence profoundly affects blood glucose management in patients with type 2 diabetes. Measures to contain the COVID-19 pandemic have affected disease management and medication adherence, owing to limited access to healthcare facilities. This study aimed to examine the impact of the COVID-19 lockdown on adherence to glucose-lowering and lipid-lowering therapies (statins), and glycemic, weight, and systolic blood pressure control measures. A retrospective chart review was conducted one year pre- and post- March 18, 2020, for patients receiving glucose-lowering medications and lipid-lowering therapies (statins) in two major public hospitals in Malaysia. We compared the proportion of days covered by medication, HbA1c level, weight, and systolic blood pressure (SBP) values pre- and after the index date. A total of 1985 patients were included in this study. The adherence rate significantly increased for metformin, sulfonylureas dipeptidyl peptidase 4 inhibitors (DPP4i) and statin after the index date (metformin (PDC: 0.985 vs 0.978, p < 0.001), sulfonylureas (PDC: 0.988 vs 0.979, p < 0.01), DPP4i (PDC: 0.987 vs 0.98, p < 0.001), and statins (PDC: 0.983 vs 0.978, p < 0.05)). HbA1c levels were significantly reduced after the index follow-up (Mean difference: -0.43%, p < 0.001), while there was a 2.5 mmHg (p = 0.03) significant increase in SBP post-index follow-up. No significant changes in weight were observed during the post-index follow-up period. In this study, we observed better medication adherence and glycemic control among patients during the lockdown, but not for weight and systolic blood pressure control.
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Affiliation(s)
- Ruth Sim
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Navin Kumar Loganadan
- Department of Pharmacy, Putrajaya Hospital, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Zanariah Hussein
- Department of Medicine, Putrajaya Hospital, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Noor Lita Adam
- Department of Medicine, Hospital Tuanku Jaafar, Ministry of Health Malaysia, Seremban, Negeri Sembilan, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Center for Global Health, University of Pennsylvania, Philadelphia, PA, USA
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Troncone A, Cascella C, Chianese A, Zanfardino A, Pizzini B, Iafusco D. Psychological consequences of the COVID-19 pandemic in people with type 1 diabetes: A systematic literature review. J Psychosom Res 2023; 168:111206. [PMID: 36913765 PMCID: PMC9972771 DOI: 10.1016/j.jpsychores.2023.111206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE A comprehensive picture of the data on the impact of COVID-19 on the mental health of individuals with type 1 diabetes (T1D) is currently lacking. The purpose of this systematic review was to synthesize extant literature reporting on the effects of COVID-19 on psychological outcomes in individuals with T1D and to identify associated factors. METHODS A systematic search was conducted with PubMed, Scopus, PychInfo, PsycArticles, ProQuest, and WoS using a selection procedure according to the PRISMA methodology. Study quality was assessed using a modified Newcastle-Ottawa Scale. In all, 44 studies fulfilling the eligibility criteria were included. RESULTS Findings suggest that during the COVID-19 pandemic, people with T1D had impaired mental health, with relatively high rates of symptoms of depression (11.5-60.7%, n = 13 studies), anxiety (7-27.5%, n = 16 studies), and distress (14-86.6%, n = 21 studies). Factors associated with psychological problems include female gender, lower income, poorer diabetes control, difficulties in diabetes self-care behaviors, and complications. Of the 44 studies, 22 were of low methodological quality. CONCLUSIONS Taking appropriate measures to improve medical and psychological services is needed to support individuals with T1D in appropriately coping with the burden and difficulties caused by the COVID-19 pandemic and to prevent mental health problems from enduring, worsening, or having a long-term impact on physical health outcomes. Heterogeneity in measurement methods, lack of longitudinal data, the fact that most included studies did not aim to make a specific diagnosis of mental disorders limit the generalizability of the findings and have implications for practice.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138 Naples, Italy.
| | - Barbara Pizzini
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138 Naples, Italy
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Büyükyılmaz G, Toksoy Adıgüzel K, Koca SB. Comparison of internet usage and internet addiction scores in healthy children and children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2023; 36:435-440. [PMID: 37013724 DOI: 10.1515/jpem-2022-0640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The Internet, an integral part of modern life, can lead to internet addiction, which negatively affects academic performance, family relationships, and emotional development. This study aimed to evaluate the Internet addiction scores (IAS) during COVID-19 in children with type 1 diabetes mellitus (T1DM) compared with healthy controls. METHODS Children with T1DM and healthy controls aged 8-18, were evaluated with the Parent-Child Internet Addiction Test (PCIAT20). Internet addiction scores of the participants were assessed. The relationship between diabetes duration, mean HbA1c level and IAS were also examined in children with T1DM. RESULTS The study included 139 patients with T1DM and 273 controls. The IAS were significantly lower in patients compared with controls (25.28 ± 15.52 vs. 29.69 ± 19.08, p=0.019). There was a weak negative correlation between the duration of diabetes and IAS in children with diabetes (r=-0.21, p=0.021). There was no significant association between IAS and mean HbA1c (r=0.14, p=0.128) or age (r=0.08, p=0.115). Furthermore, there was no statistically significant difference in IAS between children with well-controlled diabetes (n: 17) and those with poorly-controlled diabetes (n: 122) (IAS: 27.1 ± 17.2; 24.8 ± 15.5, p=0.672, respectively). CONCLUSION Internet addiction scores were lower in patients with T1DM compared with their healthy peers. Unlike previous studies reporting an increase in problematic internet use, the results of the present study did not confirm internet use as a real challenge in front of the diabetes management for the majority of children with T1DM. This result may be attributed to the important role played by families in the management of T1DM.
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Affiliation(s)
- Gönül Büyükyılmaz
- Ankara Bilkent City Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Cankaya, Türkiye
| | - Keziban Toksoy Adıgüzel
- Ankara Bilkent City Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Cankaya, Türkiye
| | - Serkan Bilge Koca
- Department of Pediatrics, Division of Pediatric Endocrinology, Health Sciences University, Kayseri City Hospital, Kayseri, Türkiye
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Almeida C, Ferreira A, Duarte D, Viegas AF, Santos A, Vaz A, Nascimento E. Glycemic Control in Type 1 Diabetes Mellitus and COVID-19: What We Learned From the Lockdown Experience. Cureus 2023; 15:e33340. [PMID: 36741654 PMCID: PMC9896257 DOI: 10.7759/cureus.33340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Confinement measures that were imposed during the COVID-19 pandemic drastically changed the routines of the population. Some studies on the impact of confinement on glycemic control suggest a reduction of 0.1 to 0.5% in glycated hemoglobin. The objective of this study was to evaluate the impact of the COVID-19 pandemic lockdown on glycemic control in adult patients with type 1 diabetes mellitus. METHODS An observational retrospective cohort study of patients with type 1 diabetes mellitus followed in a Diabetes Unit was performed. The study compared the metabolic control of these patients before (between January 1st and March 18th, 2020) and after (between May 3rd and July 31st, 2020) the lockdown. RESULTS The study included 102 patients with type 1 diabetes mellitus (51% females), with a median age of 36 years (interquartile range 18.75, (24.25-43)) and a median duration of diabetes of 15 years (interquartile range 13, (8-21)). After lockdown, a significant decrease of 0.28±0.71% in glycated hemoglobin was observed (7.88±1.33% vs 7.59±1.23%, p=<0.001). In patients using continuous glucose monitoring a significant improvement in time in range was also noted (47.25±17.33% vs 49.97±18.61%, p=0.008). CONCLUSIONS This study demonstrated an improvement in glycemic control after the lockdown. This might be explained by the positive impact of stable schedules, healthy meals and greater availability to make therapeutic adjustments to glycemic control. The fact that diabetes was considered a risk factor for the development of severe COVID-19 disease might also influence patients to increase their efforts to optimize their glycemic control.
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Affiliation(s)
- Catarina Almeida
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - André Ferreira
- Department of Nephrology, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - Daniela Duarte
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - Ana Filipa Viegas
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - André Santos
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - Alexandra Vaz
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - Edite Nascimento
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
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O'Mahoney LL, Highton PJ, Kudlek L, Morgan J, Lynch R, Schofield E, Sreejith N, Kapur A, Otunla A, Kerneis S, James O, Rees K, Curtis F, Khunti K, Hartmann‐Boyce J. The impact of the COVID-19 pandemic on glycaemic control in people with diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2022; 24:1850-1860. [PMID: 35603919 PMCID: PMC9347483 DOI: 10.1111/dom.14771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
| | | | - Laura Kudlek
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Rosie Lynch
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | | | | | - Ajay Kapur
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | | | - Sven Kerneis
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | - Olivia James
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | - Karen Rees
- Freelance Systematic ReviewerWarwickshireUK
| | - Ffion Curtis
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
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10
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Ramalho D, Rouxinol-Dias A, Tavares P, Correia S, Almeida L, Alves H, Rocha G, Oliveira MJ. Glycaemic control during the COVID-19 pandemic: A catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus? ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2022; 69:476-482. [PMID: 36084987 PMCID: PMC9445843 DOI: 10.1016/j.endien.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/31/2021] [Indexed: 11/18/2022]
Abstract
Introduction In a person with type 1 diabetes, any change concerning daily routine may lead to changes in glycaemic control. This study aimed to evaluate the impact of work and lockdown on glycaemic control in adults with type 1 diabetes. Material and methods A retrospective cohort was stratified into three activity groups (g1-students/telework/laid-off; g2-unemployed/retired; g3-work without lockdown). Continuous and categorical variations (reductions ≥ 0.4%) in glycated haemoglobin were obtained in 2020 (t3:December/2019–March/2020; t4:April/2020–July/2020) and in homologous periods of 2019. Intragroup comparisons between years and intergroups in the same year were made. Regression models were developed to predict the variation of glycated haemoglobin in 2020. Results 241 participants were included, with a significant reduction between t4 and t3 (vs. t2 and t1) in g1 (p < 0.001) and g2 (p = 0.025) and in 2020 in g1 (vs. g2, p < 0.001; vs. g3, p < 0.001). Only g1 presented superiority in the reduction ≥0.4% in glycated haemoglobin in 2020 (vs. 2019, p < 0.001; vs. g2, p < 0.001; vs. g3, p < 0.001). The insulin regimens were comparable and the development of hypoglycaemia was found to be superimposed between t3 and t4, except for g1, which was higher at t3 (p = 0.029). G1 correlated with continuous reductions (vs. g2, p = 0.001; vs. g3, p < 0.001) and ≥0.4% in glycated haemoglobin in 2020 (vs. g2, OR 3.6, p < 0.001; vs. g3, OR 12.7, p < 0.001), regardless of the age and duration of type 1 diabetes. Conclusions A more stable and better glycaemic control was observed in participants who transitioned from face-to-face work to total lockdown.
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Affiliation(s)
- Diogo Ramalho
- Endocrinology and Nutrition Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Rua Conceição Fernandes, S/N, 4434-502 Vila Nova de Gaia, Portugal.
| | - Ana Rouxinol-Dias
- Center for Health Technology and Services Research, the Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Patrícia Tavares
- Endocrinology and Nutrition Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Sara Correia
- Endocrinology and Nutrition Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Lúcia Almeida
- Endocrinology and Nutrition Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Helena Alves
- Endocrinology and Nutrition Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Gustavo Rocha
- Endocrinology and Nutrition Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Maria João Oliveira
- Endocrinology and Nutrition Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
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11
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Ramalho D, Rouxinol-Dias A, Tavares P, Correia S, Almeida L, Alves H, Rocha G, Oliveira MJ. Glycaemic control during the COVID-19 pandemic: A catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus? ENDOCRINOL DIAB NUTR 2022; 69:476-482. [PMID: 35128336 PMCID: PMC8802186 DOI: 10.1016/j.endinu.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/31/2021] [Indexed: 10/24/2022]
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12
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Jabbour G, Hermassi S, Bragazzi N. Impact of the COVID-19 Pandemic on the Physical Activity Profile and Glycemic Control Among Qatari Adults With Type 1 Diabetes: Effect of Vaccination Status. Front Public Health 2022; 10:914117. [PMID: 35903394 PMCID: PMC9315145 DOI: 10.3389/fpubh.2022.914117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the impact of COVID-19, as an influent barrier on physical activity (PA) patterns and glycemic control in Qatari adults with type 1 diabetes (T1D). As the COVID-19 vaccine may have a potential impact on an individual's lifestyle, we also considered this parameter. Methods Physical activity level, the exercise barriers (BAPAD1), anthropometric characteristics, the method of insulin administration, and the last glycated hemoglobin in % were completed by 102 Qatari adults with T1D. Moreover, all patients were asked whether they had “been vaccinated” or had a “fear of being infected by COVID-19”. Results For the unvaccinated group, weight, BMI and HbA1c (%) were significantly higher than those of vaccinated group (p < 0.01) and engaged in less moderate-to-vigorous PA (MVPA) (p < 0.01) per week and had less time in vigorous PA (VPA) (p < 0.01). A significant association between VPA levels and BMI (β = −0.36, p = 0.02) and HbA1C (%) (β = −0.22; p = 0.03) was reported, and “being vaccinated” was significantly associated with MVPA (β = 0.15; p = 0.021) and VPA (β = 0.28; p = 0.032). A higher “Fear of being infected by COVID-19” score was negatively correlated with reduced PA profiles (R2 = −0.71 for MVPA; R2 = −0.69 for VPA, p < 0.01, respectively). Conclusion Practicing VPA during the COVID-19 pandemic confer many health benefits for Qatari individual with T1D. As the “Fear of being affected by COVID-19” appeared as a potential barrier to PA practices this latter e.g. PA, could likely not be achieved without the participants being vaccinated.
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Affiliation(s)
- Georges Jabbour
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
- *Correspondence: Georges Jabbour ;
| | - Souhail Hermassi
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
| | - Nicola Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy
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13
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Pica S, Morano C, Díez LR. A role for the diabetes nurse educator to telemedically support children with type 1 diabetes on continuous glucose monitoring? The COVID-19 lockdown experience. Prim Care Diabetes 2022; 16:365-367. [PMID: 35351390 DOI: 10.1016/j.pcd.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
The role of diabetes nurse educators during the COVID-19 lockdown to telematically provide routine reviews of glycaemic control in children with type 1 diabetes (T1D) using continuous glucose monitoring systems is evaluated. Implementing these routines in the day-to-day clinical practice could reduce in-person clinic visits and improve glucose control.
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Affiliation(s)
- Susana Pica
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Spain.
| | - Carmen Morano
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Spain.
| | - Luis-Rogelio Díez
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain.
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14
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Ayele TA, Shibru H, Mequanent Sisay M, Melese T, Fentie M, Azale T, Belachew T, Shitu K, Alamneh TS. The effect of COVID-19 on poor treatment control among ambulatory Hypertensive and/or Diabetic patients in Northwest Ethiopia. PLoS One 2022; 17:e0266421. [PMID: 35588110 PMCID: PMC9119481 DOI: 10.1371/journal.pone.0266421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background
Diabetes and hypertension have emerged as important clinical and public health problems in Ethiopia. The need to have long-term sustainable healthcare services for patients with diabetes and hypertension is essential to enhance good treatment control among those patients and subsequently delay or prevent complications. A collective shift towards acute care for COVID-19 patients combined with different measures to contain the pandemic had disrupted ambulatory care. Hence, it is expected to have a significant impact on treatment control of hypertensive and diabetic patients. However, there is limited evidence on the effect of the pandemic on treatment control and its determinants. Therefore, this study aimed to assess the effect of COVID-19 pandemic on treatment control of ambulatory Hypertensive and Diabetic patients and identify the factors for poor treatment control in North West Ethiopia.
Methods
A retrospective chart review and cross-sectional survey design were conducted between December 2020 and February 2021. Using a stratified systematic random sampling technique, 836 diabetic and/or hypertensive patients were included in the study. Web-based data collection was done using Kobo collect. The changes in the proportion of poor treatment control among ambulatory Hypertensive and/or Diabetic patients during the COVID-19 pandemic period were assessed. A multivariable binary logistic regression mixed model was fitted to identify the determinants of poor treatment control. The odds ratios were reported in both crude and adjusted form, together with their 95% confidence intervals and p-values.
Result
Poor treatment control increased significantly from 24.81% (21.95, 27.92) prior to the COVID-19 pandemic to 30.33% (27.01, 33.88), 35.66% (32.26, 39.20), 36.69% (33.40, 40.12), and 34.18% (3102, 37.49) in the first, second, third, and fourth months following the date of the first COVID-19 case detection in Ethiopia, respectively. Marital status (AOR = 0.56, 95%CI; 0.41, 0.74), regimen of medication administration (AOR = 1.30, 95%CI; 1.02, 166), daily (AOR = 0.12, 95%CI; 0.08, 0.20), twice (AOR = 0.42, 95%CI; 0.30. 0.59), and three times (AOR = 0.31, 95%CI; 0.21, 0.47) frequency of medication, number medications taken per day (AOR = 0.79, 95%CI;0.73, 0.87), patients habits like hazardous alcohol use (AOR = 1.29, 95%CI; 1.02, 1.65) and sedentary lifestyle (AOR = 1.72,95%CI;1.46, 2.02), missed appointment during the COVID-19 pandemic (AOR = 2.09, 95%CI; 1.79, 2.45), and presence of disease related complication (AOR = 1.11, 95%CI; 0.93, 1.34) were significantly associated with poor treatment control among Diabetic and/or hypertensive patients during the COVID-19 pandemic.
Conclusion
The COVID-19 pandemic had a substantial impact on ambulatory Diabetic and/or Hypertensive patients’ treatment control. Being married, as well as the frequency and types of medicines taken per day were all found to be negatively associated with poor treatment control. During the COVID -19 pandemic, patients’ habits such as hazardous alcohol use and sedentary lifestyle, longer follow-up time, having disease-related complication (s), patients taking injectable medication, number of medications per day, and missed appointments were positively associated with poor treatment control in ambulatory diabetic and hypertensive patients. Therefore, it is better to consider the risk factors of poor treatment control while designing and implementing policies and strategies for chronic disease control.
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Affiliation(s)
- Tadesse Awoke Ayele
- Epidemiology & Biostatistics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtewold Shibru
- Internal Medicine Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Epidemiology & Biostatistics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfahun Melese
- Health Informatics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkitu Fentie
- Health Informatics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Health Education & Behavioural Sciences Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Kegnie Shitu
- Health Education & Behavioural Sciences Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Epidemiology & Biostatistics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
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Kaddar R, Tarik C, Atmani M, Enakhil I, Fakhri N, Khalis M, Lotfy A, El Kadmiri N. Effect of COVID-19 lockdown on Moroccan patients with type 1 and type 2 diabetes. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:142. [PMID: 35601474 PMCID: PMC9109193 DOI: 10.1186/s42269-022-00827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The implementation of coronavirus disease of 2019 (COVID-19) lockdown has affected the daily practices of subjects with chronic diseases such as diabetes and caused negative impact on their lifestyle and habits such as physical activity, dietary habits and accessibility to medications. Diabetic people are considered the most vulnerable groups to COVID-19, and the lockdown measure has disturbed the diabetes self-management. In our study, we aimed to assess, for the first time at the regional level (Souss Massa Region), the COVID-19 lockdown impact on HbA1c levels in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). We carried out a cross-sectional quantitative analysis at the health center of the industrial district in Agadir City. RESULTS We found a significant improvement in post-lockdown mean ± SD HbA1c in 150 subjects suffering from T1D and T2D; p = 0.005). Our analysis revealed a significant association of HbA1c deviation with educational level and medical coverage (p = 0.01). No significant association was detected between HbA1c deviation and age, gender, weight, height, current BMI status, fasting blood sugar, family history, urban or rural areas, marital status, professional activity, socioeconomic income, type of diabetes, dietary, comorbidities, diabetic complications, housing, adherence to the dietary recommendations, physical activity, medical appointments, stopping medication, self-monitoring, fasting and anxiety about getting COVID-19. CONCLUSIONS COVID-19 lockdown had no deleterious effect on HbA1c levels in Moroccan patients with T1D and T2D.
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Affiliation(s)
- Rochdi Kaddar
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
- Regional Direction of Health and Social Protection, Souss Massa Region, Agadir City, Morocco
| | - Chayma Tarik
- High Institute of Nursing Professions and Health Techniques of Agadir, Agadir City, Morocco
| | - Maryam Atmani
- High Institute of Nursing Professions and Health Techniques of Agadir, Agadir City, Morocco
| | - Ikrame Enakhil
- High Institute of Nursing Professions and Health Techniques of Agadir, Agadir City, Morocco
| | - Nada Fakhri
- High Institute of Nursing Professions and Health Techniques of Agadir, Agadir City, Morocco
- Molecular Engineering, Valorization and Environment Team, Polydisciplinary Faculty of Taroudant, IBN ZOHR University, B.P. 271, 83 000 Taroudannt City, Morocco
| | - Mohamed Khalis
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Abdellah Lotfy
- High Institute of Nursing Professions and Health Techniques of Agadir, Agadir City, Morocco
| | - Nadia El Kadmiri
- Molecular Engineering, Valorization and Environment Team, Polydisciplinary Faculty of Taroudant, IBN ZOHR University, B.P. 271, 83 000 Taroudannt City, Morocco
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16
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Ali N, El Hamdaoui S, Nefs G, Tack CJ, De Galan BE. Improved glucometrics in people with type 1 diabetes 1 year into the COVID-19 pandemic. BMJ Open Diabetes Res Care 2022; 10:10/3/e002789. [PMID: 35606020 PMCID: PMC9125382 DOI: 10.1136/bmjdrc-2022-002789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/01/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Various studies have shown a number of glycemic parameters to improve over several weeks in people with type 1 diabetes during the first surge of the COVID-19 pandemic. Whether and to what extent such improvement is sustained during following COVID-19 surges remains unknown. Therefore, the aim of this study was to investigate glycemic parameters during the first year of the COVID-19 pandemic in people with type 1 diabetes and to determine factors associated with glycemic improvement. RESEARCH DESIGN AND METHODS This was an observational cohort study in people with type 1 diabetes, aged ≥16 years. We compared glycated hemoglobin (HbA1c) and flash glucose monitoring (FGM) downloads between the prelockdown period and approximately 1 year thereafter. Using logistic regression analysis, we assessed associations between an HbA1c reduction of at least 0.5% (~5.5 mmol/mol) with baseline clinical characteristics and self-reported changes in psychological well-being and lifestyle behavior related to COVID-19. RESULTS A total of 437 participants were included. As compared with prepandemic data, 1 year after the start of the COVID-19 pandemic and associated lockdowns, HbA1c had decreased from 7.9%±1.1% (63±12 mmol/mol) to 7.5%±1.0% (59±11 mmol/mol) (p<0.001), whereas time in range increased from 55.8%±16.7% to 58.6%±16.7% (p=0.004) and time below (<3.9 mmol/L) and above (>13.9 mmol/L) range and glucose variability all decreased (all p<0.05). FGM use, higher HbA1c at baseline and current smoking were independently associated with an HbA1c decrease of at least 0.5%, whereas self-reported changes in psychological well-being and lifestyle behavior related to the first surge of the COVID-19 pandemic and associated lockdowns were not. CONCLUSIONS The COVID-19 pandemic and related lockdown measures were associated with improvement in glucometrics, including HbA1c and FGM data, in individuals with type 1 diabetes, particularly in FGM users, those with higher HbA1c at baseline or current smokers.
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Affiliation(s)
- Namam Ali
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Soumia El Hamdaoui
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboudumc Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, Netherlands
| | - Cornelis J Tack
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Bastiaan E De Galan
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
- Internal Medicine/Endocrinology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
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Dissanayake H, Soysa P, Samarathunga T, De Silva L, Samaranayake N, Padmaperuma C, Katulanda P. Impact of COVID-19 lockdown on people living with diabetes: Experience from a low-middle income country in South Asia. Prim Care Diabetes 2022; 16:127-134. [PMID: 34974994 PMCID: PMC8651510 DOI: 10.1016/j.pcd.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 01/19/2023]
Abstract
AIMS COVID-19 lockdown imposes many challenges to patients with diabetes. We aimed to assess the impact of COVID-19 lockdown on health-related behavior and disease control among patients with diabetes. MATERIALS AND METHODS A cross-sectional study was conducted among adults with diabetes attending a diabetes clinic in Colombo, Sri Lanka in June-July 2020. Lifestyle and disease control changes before and during the lockdown, were determined using an interviewer-administered questionnaire and review of medical records. RESULTS Among 1727 participants mean HbA1c decreased by 0.30% (95% CI 0.24-0.36, p < 0.001). HbA1c improved in 37.6% but deteriorated in 18.8%. Male sex (OR 1.36, 95% CI 1.10-1.67), better education (OR 1.10, 95% CI 1.01-1.20) and being employed (OR 1.08, 95% CI 1.00-1.16) were sociodemographic predictors of improved control. Better dietary adherence (OR 1.55, 95% CI 1.13-2.12), night-time sleep (OR 1.46, 95% CI 1.13-1.88) and indoor exercise (OR 1.62, 95% CI 1.23-2.07) were behavioural determinants of improved glycaemia. Decreases in self-monitoring of blood glucose (OR 1.45, 95% CI 1.09-1.93), exercise (OR 1.7, 95% CI 1.32-2.20), medication use (OR 1.95, 95% CI 1.37-2.78), dietary adherence (OR 1.72, 95% CI 1.32-2.26) and family income (OR 1.45, 95% CI 1.12-1.88) predicted worsening glycaemia. Only 4.1% used telehealth services; 83.1% of them reported good satisfaction. CONCLUSIONS Mean HbA1c improved during the lockdown. Overall, 37.6% of participants improved their glycaemic control. Well-educated employed men were more likely to improve glycaemic status. Improving diabetes control through healthy lifestyle practices and self-monitoring are feasible even in resource limited settings.
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Affiliation(s)
- Harsha Dissanayake
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo 008, Sri Lanka; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo 008, Sri Lanka.
| | - Pasindu Soysa
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo 008, Sri Lanka.
| | - Thilina Samarathunga
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo 008, Sri Lanka.
| | - Laksara De Silva
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo 008, Sri Lanka.
| | - Nadeesh Samaranayake
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo 008, Sri Lanka.
| | | | - Prasad Katulanda
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo 008, Sri Lanka; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo 008, Sri Lanka; Cruddas Link Fellow, Harris Manchester College, University of Oxford, Oxford, UK.
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Silverii GA, Delli Poggi C, Dicembrini I, Monami M, Mannucci E. Glucose control in diabetes during home confinement for the first pandemic wave of COVID-19: a meta-analysis of observational studies. Acta Diabetol 2021; 58:1603-1611. [PMID: 34159476 PMCID: PMC8219181 DOI: 10.1007/s00592-021-01754-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/29/2021] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Giovanni Antonio Silverii
- Diabetes Unit, Experimental and Clinical Biomedical Sciences "Mario Serio" Department, AOU Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Chiara Delli Poggi
- Diabetes Unit, Experimental and Clinical Biomedical Sciences "Mario Serio" Department, AOU Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Ilaria Dicembrini
- Diabetes Unit, Experimental and Clinical Biomedical Sciences "Mario Serio" Department, AOU Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Matteo Monami
- Diabetes Unit, Experimental and Clinical Biomedical Sciences "Mario Serio" Department, AOU Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Edoardo Mannucci
- Diabetes Unit, Experimental and Clinical Biomedical Sciences "Mario Serio" Department, AOU Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Mohseni M, Ahmadi S, Azami-Aghdash S, Mousavi Isfahani H, Moosavi A, Fardid M, Etemadi M, Ghazanfari F. Challenges of routine diabetes care during COVID-19 era: A systematic search and narrative review. Prim Care Diabetes 2021; 15:918-922. [PMID: 34393092 PMCID: PMC8326007 DOI: 10.1016/j.pcd.2021.07.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The world is facing the current COVID-19 pandemic. The pandemic response is affecting routine health care provision all over the world. We aimed to review the relevant literature and highlight challenges in the provision of routine care for patients with diabetes during the COVID-19 outbreak. METHODS We systematically searched PubMed, ScienceDirect, and Embase databases up till August 13, 2020 and retrieved relevant articles published on difficulties on routine diabetes management during the COVID-19 pandemic. RESULTS Through our reading of the recent literature discussing the difficulties of routine healthcare provision for patients with diabetes amid the COVID-19 pandemic, we have identified nine themes as follows: lockdown of standard outpatient clinics, decreased inpatient capacity, staff shortage, medicine shortage, unaffordable medicine, delayed care seeking, limited self-care practice, transport difficulties, and undiagnosed cases/events. CONCLUSION Diabetes management during lockdown is particularly challenging. This review specified a summary of difficulties of diabetes care during COVID-19 pandemic. Healthcare policy makers as well as healthcare providers could take advantage of the results of this review to mitigate the adverse effect of the crisis on provision of routine care for diabetes as well as other chronic conditions.
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Affiliation(s)
- Mohammad Mohseni
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiler Ahmadi
- Department of Nursing and Midwifery, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haleh Mousavi Isfahani
- Departments of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Moosavi
- Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Mozhgan Fardid
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Manal Etemadi
- Departments of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ghazanfari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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20
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Garofolo M, Aragona M, Rodia C, Falcetta P, Bertolotto A, Campi F, Del Prato S, Penno G. Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies. Diabetes Res Clin Pract 2021; 180:109066. [PMID: 34563586 PMCID: PMC8458100 DOI: 10.1016/j.diabres.2021.109066] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/06/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Monia Garofolo
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Michele Aragona
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cosimo Rodia
- Section of Endocrinology, ASL Brindisi, DSS-1, Brindisi, Italy
| | - Pierpaolo Falcetta
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandra Bertolotto
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Fabrizio Campi
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Stefano Del Prato
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Giuseppe Penno
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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21
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Eberle C, Stichling S. Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review. Diabetol Metab Syndr 2021; 13:95. [PMID: 34493317 PMCID: PMC8423337 DOI: 10.1186/s13098-021-00705-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2019, a new virus known as severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has emerged. Coronavirus disease 2019 (COVID-19) was classified as a pandemic in a short period of time. In order to reduce the spread of COVID-19, many countries have imposed a lockdown with movement restrictions, social distancing and home confinement, which has affected routine healthcare activities and everyday life. The aim of this systematic review was to examine the impact of the COVID-19 lockdown on glycemic control in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS We systematically identified studies by searching the databases Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, EMBASE, and CINAHL until April 2021. We included n = 33 observational studies of which n = 25 investigated T1D and n = 8 T2D. RESULTS Overall, we analyzed n = 2881 T1D patients and n = 1823 T2D patients. Glycemic values in patients with T1D improved significantly during lockdown. Overall, n = 18 (72%) T1D studies indicated significant improvements in glycemic outcomes. Meta-analysis revealed a mean difference in HbA1c of - 0.05% (95% CI - 0.31 to 0.21) due to lockdown, and in time in range (TIR) of + 3.75% (95% CI 2.56 to 4.92). Lockdown determined a short-term worsening in glycemic values in patients with T2D. Overall, n = 4 (50%) publications observed deteriorations in glycemic control. Meta-analysis demonstrated a mean difference in HbA1c of + 0.14 (95% CI - 0.13 to 0.40) through the lockdown. Moreover, n = 3 (75%) studies reported a not significant deterioration in body weight. CONCLUSIONS Glycemic values in people with T1D significantly improved during COVID-19 lockdown, which may be associated with positive changes in self-care and digital diabetes management. In contrast, lockdown rather determined a short-term worsening in glycemic parameters in patients with T2D. Further research is required, particularly into the causes and effective T2D management during lockdown.
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Affiliation(s)
- Claudia Eberle
- Medicine With Specialization in Internal Medicine and General Medicine, Hochschule Fulda-University of Applied Sciences, Leipziger Strasse 123, 36037, Fulda, Germany.
| | - Stefanie Stichling
- Medicine With Specialization in Internal Medicine and General Medicine, Hochschule Fulda-University of Applied Sciences, Leipziger Strasse 123, 36037, Fulda, Germany
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22
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Danne T, Limbert C, Puig Domingo M, Del Prato S, Renard E, Choudhary P, Seibold A. Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future. Diabetes Ther 2021; 12:2289-2310. [PMID: 34338994 PMCID: PMC8327601 DOI: 10.1007/s13300-021-01114-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/01/2021] [Indexed: 01/08/2023] Open
Abstract
People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70-180 mg/dL (3.9-10 mmol/L) increased across 19/27 cohorts with a median 3.3% (- 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.
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Affiliation(s)
- Thomas Danne
- Diabetes Center for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Germany.
| | - Catarina Limbert
- Unit for Paediatric Endocrinology and Diabetes, CHULC, Hospital Dona Estefania, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Manel Puig Domingo
- Endocrinology and Nutrition Service, Department of Medicine, Germans Trias i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Department of Physiology, Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Pratik Choudhary
- Department of Diabetes and Nutritional Sciences, King's College London, London, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
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23
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Cheng HP, Wong JSL, Selveindran NM, Hong JYH. Impact of COVID-19 lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 and type 2 diabetes mellitus. Endocrine 2021; 73:499-506. [PMID: 34244903 PMCID: PMC8270233 DOI: 10.1007/s12020-021-02810-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/21/2021] [Indexed: 01/06/2023]
Abstract
AIMS Malaysia implemented nationwide lockdown from 18th March till 3rd May 2020 to mitigate the spread of coronavirus disease (COVID-19). This study aimed to examine the impact of the lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 (T1DM) and 2 diabetes mellitus (T2DM) aged less than 18 years old. METHODS In this cross-sectional study, interviews and a standardised questionnaire comparing lifestyle changes before and during the lockdown were performed in follow-up clinic visits after the lockdown. Anthropometry measurements and glycated haemoglobin (HbA1c) values were compared 3 months prior and after the lockdown. RESULTS Participants were 93 patients with T1DM (11.08 ± 3.47 years) and 30 patients with T2DM (13.81 ± 2.03 years). Male gender, T2DM and pubertal adolescents were found to have a significant deterioration in glycaemic control. A significant increment of HbA1c was observed in patients with T2DM (8.5 ± 0.40 vs 9.9 ± 0.46%), but not in patients with T1DM (8.6 ± 0.28 vs 8.7 ± 0.33%). Contrarily, there was an improved glycaemic control in pre-pubertal T1DM children likely due to parental supervision during home confinement. Weight and BMI SDS increased in T1DM patients but surprisingly reduced in T2DM patients possibly due to worsening diabetes control. Reduced meal frequency mainly due to skipping breakfast, reduced physical activity level scores, increased screen time and sleep duration were observed in both groups. CONCLUSIONS Adverse impact on glycaemic control and lifestyle were seen mostly in patients with T2DM and pubertal adolescent boys.
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Affiliation(s)
- Hooi Peng Cheng
- Paediatric Endocrine Unit, Putrajaya Hospital, 62250, Putrajaya, Malaysia.
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24
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Lombardo F, Salzano G, Bombaci B, Basile P, Lucania G, Alibrandi A, Passanisi S. Has COVID-19 lockdown improved glycaemic control in pediatric patients with type 1 diabetes? An analysis of continuous glucose monitoring metrics. Diabetes Res Clin Pract 2021; 178:108988. [PMID: 34331977 PMCID: PMC8416096 DOI: 10.1016/j.diabres.2021.108988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
AIMS Our observational study aimed to evaluate the impact of the lockdown period due to 2019 Coronavirus disease pandemic on glycaemic control in a cohort of paediatric patients with type 1 diabetes (T1D). METHODS Eighty-five patients with T1D aged 5-18 years using continuous glucose monitoring (CGM) systems were enrolled. Demographic and clinical data, including glucose metrics generated by CGM-specific web-based cloud platforms, were collected in three different periods (pre-lockdown phase, lockdown phase, and post-lockdown phase) of 90 days each and were statistically analysed. RESULTS During the lockdown period, a clear improvement in almost all CGM metrics (time in range, time above range, coefficient of variation, and glucose management indicator) was observed in our study population, regardless of age and insulin type treatment. In the months following lockdown, maintaining satisfactory diabetes outcomes was confirmed only in younger patients (aged 5-9 years) and in those individuals on hybrid closed loop therapy. CONCLUSIONS The increasing use of innovative technological devices together with data sharing systems and interaction with multidisciplinary diabetes team through telemedicine allowed paediatric patients with T1D to improve glucose metrics during the lockdown period. However, our findings showed that the achievement of better glycaemic control was transient for most patients.
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Affiliation(s)
- Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy.
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Pietro Basile
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giovanni Lucania
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
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25
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Wong VW, Wang A, Manoharan M. Utilization of telehealth for outpatient diabetes management during COVID-19 pandemic: how did the patients fare? Intern Med J 2021; 51:2021-2026. [PMID: 34227718 PMCID: PMC8447012 DOI: 10.1111/imj.15441] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/22/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
Background During the Coronavirus disease 2019 (COVID‐19) pandemic, many outpatient services at public hospitals, including diabetes services, had adopted telehealth appointments for their clinic patients. There was concern that patients' glycaemic control may worsen during the pandemic. Aim To assess glycaemic control of patients with diabetes attending telehealth consultations in 2020, compared to face‐to‐face reviews prior to pandemic. Methods We conducted a retrospective review of patients with diabetes managed by telehealth consultations over 5 months at two metropolitan hospitals in Sydney. Their attendance rate, glycaemic control and unplanned admissions to hospital were assessed, and these were compared with the same period 12 months prior when patients were reviewed via face‐to‐face appointments. Results Between April and September 2020, the attendance rate for telehealth consultation at the diabetes services at the two hospitals was 88.9% (884 out of 994), which was higher than in 2019 (85.2%; 818 out of 959; P = 0.016) when patients attended via face‐to‐face appointments. Of the 629 patients reviewed via telehealth in 2020 and who had been with our service for over 12 months, glycaemic control was better in 2020 (HbA1c 7.8 ± 1.4% (62 ± 15 mmol/mol)) compared with 12 months earlier (8.2 ± 1.7% (66 ± 19 mmol/mol); P < 0.001). There was no difference in the number of unplanned admissions for this cohort in 2020 (n = 58; 9.2%) compared with 2019 (n = 75; 11.9%; P = 0.100). Conclusions The present study showed that for patients with diabetes who received care via telehealth consultations during the COVID‐19 lockdown, their glycaemic control was slightly better, and unplanned admission rates were not higher compared with those in the pre‐COVID‐19 period. Telehealth consultation offers an important care delivery option in the management of patients with diabetes under these circumstances.
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Affiliation(s)
- Vincent W Wong
- Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, New South Wales.,Diabetes Service, Fairfield Hospital, Fairfield, New South Wales.,South Western Sydney Clinical School University of New South Wales
| | - Alexandra Wang
- Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, New South Wales
| | - Manimegalai Manoharan
- Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, New South Wales.,Diabetes Service, Fairfield Hospital, Fairfield, New South Wales
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26
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Wilk M, Surowiec P, Matejko B, Wróbel A, Zięba-Parkitny J, Cyganek K, Huras H, Małecki MT. Diabetes Management Delivery and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus during the First Wave of the 2020 COVID-19 Pandemic: A Single-Reference Center Report. J Diabetes Res 2021; 2021:5515902. [PMID: 34307689 PMCID: PMC8279845 DOI: 10.1155/2021/5515902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has forced a rapid adaptation of healthcare services to secure care for many patient groups. This includes women with gestational diabetes mellitus (GDM). We evaluated the impacts of the first COVID-19 wave on parameters such as the GDM treatment, glycemic control, and pregnancy outcomes. METHODS In this retrospective study from a reference diabetes center (Krakow, Poland), we compared patient data from two different time periods: the first wave of the COVID-19 pandemic (March 2020-June 2020) and the preceding five months (October 2019-February 2020). Data was collected from the medical records and telephone surveys. RESULTS We included 155 consecutive women (group N1 = 73 and group N2 = 82 from the COVID-19 pandemic period and non-COVID-19 period, respectively). During the COVID-19 pandemic, almost half of all GDM women (N1 = 36, 49.3%) used telemedicine as a method of contacting their diabetic specialists while this tool was not utilized in the earlier period. Moreover, these patients reported difficulties in performing blood glucose self-control more often (N1 = 20, 27.4%, vs N2 = 7, 8.5%; p ≤ 0.01) and spent less time on diabetes education than the control group on average (N1 = 39, 53.4%, vs N2 = 9, 9.8% below 2 hours of training; p ≤ 0.01). Most analyzed glycemic parameters and pregnancy outcomes were similar. Differences were found with respect to the incidence of prolonged labor (N1 = 12, 16.4%, vs N2 = 3, 3.7%; p ≤ 0.01) and preeclampsia (N1 = 0 vs N2 = 7, 8.5%; p = 0.01). CONCLUSION In this single-center observational study, the first wave of the COVID-19 pandemic did not seem to have a negative impact on pregnancy outcomes in GDM women, despite the difficulties in diabetes management delivery.
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Affiliation(s)
- Magdalena Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Paulina Surowiec
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Albert Wróbel
- Students' Scientific Group, Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | | | - Katarzyna Cyganek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Hubert Huras
- University Hospital, Krakow, Poland
- Department of Obstetrics and Perinatology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T. Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
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27
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Study on the effects of changes in lifestyle of patients with diabetes on glycaemic control before and after the declaration of the state of emergency in Japan. Diabetol Int 2021; 13:66-74. [PMID: 33898154 PMCID: PMC8056092 DOI: 10.1007/s13340-021-00505-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/03/2021] [Indexed: 12/23/2022]
Abstract
Objective To investigate the actual conditions of changes in lifestyle and treatment status of patients with diabetes before and after the declaration of the state of emergency issued in response to the novel coronavirus. Methods This study was a collaborative study in two diabetes clinics. A total of 1000 subjects responded to the questionnaire. In addition, data on HbA1c and body weight before and after the declaration of the state of emergency were collected. Results HbA1c levels significantly decreased from 7.28 ± 0.97% before the declaration of the state of emergency to 7.07 ± 0.86% after the declaration (p < 0.001). A significant decrease in HbA1c levels was also noted in both T2DM and T1DM. A factorial analysis of the change in HbA1c levels found that a high HbA1c level before the declaration was the most influential factor that made the HbA1c level more likely to decrease, with such factors including a good amount of exercise. A positive correlation with change in body weight was noted. Factors that made the HbA1c level less likely to decrease included stress felt about school closures for children, increased opportunities to eat out, increased food consumption, and refraining from exercise to avoid the “Three Cs” (crowded places, close-contact settings, and confined and enclosed spaces). Conclusion In the absence of serious economic stagnation or completely disrupted distribution, patients are allowed time to do what they like and can probably improve their glycaemic control status if they see this time as an opportunity. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-021-00505-6.
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Minuto N, Bassi M, Montobbio C, Vinci F, Mercuri C, Perri FN, Cabri M, Calevo MG, d’Annunzio G, Maghnie M. The Effect of Lockdown and Physical Activity on Glycemic Control in Italian Children and Young Patients With Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:690222. [PMID: 34326814 PMCID: PMC8315148 DOI: 10.3389/fendo.2021.690222] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS The purpose of the study was to evaluate the impact of the lockdown established by the Italian government to limit the spread of Coronavirus disease (COVID-19) on glycemic control in a large sample of patients with type 1 diabetes (T1D) based on age, type of insulin therapy, number of telemedicine visits and physical activity. MATERIAL AND METHODS We retrospectively evaluated glycemic control in young T1D patients using the DexcomG6® system before the Italian lockdown (February 10-23, 2020-Time 0) and during lockdown (April 17-30, 2020-Time 1). Data on age, type of insulin therapy, number of telemedicine visits and physical activity of 202 patients with T1D and a median age of 18.2 years (range: 6-39) were collected. RESULTS Data showed a significant improvement of TIR from 54.58% at T0 to 59.09% at T1 (p ≤0.0001). Glycemic control improved significantly in patients ≥14 years old, showing the best outcome in the "university students and young adults" group (55.40% at T0 and 61.37% at T1, p ≤0.001). All patients reduced physical activity during lockdown; in the 56 patients of "intense physical activity" group both at T0 and T1 TIR increased from ±56.91 to 64.11% (p ≤0.0001). CONCLUSIONS Overall, the lockdown led to an unexpected improvement in glycemic control of young patients with T1D. A healthier and stressless lifestyle changes in association with the maintenance of physical activity resulted in a significant age-proportional improvement in glycemic control.
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Affiliation(s)
- Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- *Correspondence: Marta Bassi,
| | - Carolina Montobbio
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Francesco Vinci
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Claudia Mercuri
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Francesca Nastasia Perri
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mara Cabri
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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Nassar M, Nso N, Baraka B, Alfishawy M, Mohamed M, Nyabera A, Sachmechi I. The association between COVID-19 and type 1 diabetes mellitus: A systematic review. Diabetes Metab Syndr 2021; 15:447-454. [PMID: 33592371 PMCID: PMC7872855 DOI: 10.1016/j.dsx.2021.02.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND /Aim: Various reports of the occurrence of type 1 diabetes mellitus (T1DM) in patients with COVID-19 have been published, denoting an association between both diseases. Therefore, we conducted this systematic review to summarize the prevalence of T1DM in COVID-19 patients and to identify the clinical presentations and outcomes in this patient population. MATERIALS AND METHODS Up to 10/27/2020, Medline, Embase, cochrane and google scholar databases were searched for original studies investigating the association between COVID-19 and T1DM. A manual search was conducted to identify missing studies. The quality of included studies was analyzed by the National Institute of Health (NIH) risk of bias tool. Outcomes included length of hospital stay, hospitalization, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), severe hypoglycemia, and death. RESULTS Fifteen studies were included in the qualitative analysis. Included studies reported data of both adult and pediatric patients. The prevalence of T1DM in COVID-19 patients ranged from 0.15% to 28.98%, while the rate of COVID-19 in patients with T1DM ranged from 0% to 16.67%. Dry cough, nausea, vomiting, fever and elevated blood glucose levels were the most commonly reported presentations. The investigated outcomes varied widely among studied populations. CONCLUSIONS The prevalence of T1DM in patients with COVID-19 ranged from 0.15% to 28.98%. The most common presentation of COVID-19 in patients with T1DM included fever, dry cough, nausea and vomiting, elevated blood glucose and diabetic ketoacidosis. The outcomes of COVID-19 in terms of length of hospital stay, hospitalization, ICU admission, DKA rate, and severe hypoglycemia were reported variably in included studies. Due to the heterogeneous study populations and the presence of many limitations, more studies are still warranted to reach a definitive conclusion.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, NY, USA.
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, NY, USA.
| | - Bahaaeldin Baraka
- Oncology Department, Southend University Hospital, Mid and South Essex NHS Foundation Trust, ESSEX, UK.
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo, Egypt.
| | - Mahmoud Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, USA.
| | - Akwe Nyabera
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, NY, USA.
| | - Issac Sachmechi
- Division of Endocrinology, Department of Medicine, Mount Sinai Services, Queens Hospital, Center, NY, USA.
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