Impact of COVID-19 Lockdown on Glycemic Control in Adults With Type 1 Diabetes Mellitus

Begoña Pla; Alfonso Arranz; Carolina Knott; Miguel Sampedro; Sara Jiménez; Iñigo Hernando; Monica Marazuela

Disclosures

J Endo Soc. 2020;4(12) 

In This Article

Abstract and Introduction

Abstract

Aim: To examine the impact of the lockdown caused by the COVID-19 pandemic on both the glycemic control and the daily habits of a group of patients with type 1 diabetes mellitus (T1DM) using flash continuous glucose monitoring devices (flash CGMs).

Methods: Retrospective analysis based on all the information gathered in virtual consultations from a cohort of 50 adult patients with T1DM with follow-up at our site. We compared their CGM metrics during lockdown with their own previous data before the pandemic occurred, as well as the potential psychological and therapeutic changes.

Results: We observed a reduction of average glucose values: 160.26 ± 22.55 mg/dL vs 150 ± 20.96 mg/dL, P = .0009; estimated glycosylated hemoglobin: 7.21 ± 0.78% vs 6.83 ± 0.71%, P = .0005; glucose management indicator 7.15 ± 0.57% vs 6.88 ± 0.49%; P = .0003, and glycemic variability: 40.74 ± 6.66 vs 36.43 ± 6.09 P < .0001. Time in range showed an improvement: 57.46 ± 11.85% vs a 65.76 ± 12.09%, P < .0001, without an increase in percentage of time in hypoglycemia.

Conclusions: COVID-19 lockdown was associated with an improvement in glycemic control in patients with T1DM using CGMs.

Introduction

The COVID-19 pandemic is the biggest global health emergency we have known in the last 100 years. Its great impact on our lives involves totally breaking with many social harmony rules, which will remain affected by this pandemic to an extent, at least in the near future. Spain, and especially Madrid, has been one of the worst affected places. Governments from different countries have been forced to adopt legal measures in the critical infection phase to slow down the spread of the COVID-19. On March 14, 2020, the Spanish government released an executive order for exceptional circumstances for the management of the health crisis caused by COVID-19.

Our study covers a period of 14 days from 11 April onwards, for we consider that it was the most difficult phase of lockdown after spending 4 weeks in a state of alarm, a situation that involved strict measures such as complete confinement at home, social distancing unless unavoidable, and the shutdown of all businesses except those with essential workers. Lockdown has involved a drastic change in everyone's daily habits as well as in family, social, and work relationships with evident psychosocial consequences.[1,2]

According to the health authorities, people with diabetes seem to be one of the groups most vulnerable to COVID-19. Therefore, scientific organizations have established specific recommendations to avoid contagion of the virus and to assist management of the disease.[3] The restrictive measures mentioned above, the perception of being in a high-risk group for COVID-19, and the determinants inherent to the disease itself entail an important emotional impact on people with diabetes.[4] Moreover, people with type 1 diabetes mellitus (T1DM) might require therapeutic adjustments, quite complex sometimes, to maintain the objectives of metabolic control.

This research aims to study the impact of social and work confinement on glycemic control in a cohort of patients with T1DM who use continuous glucose monitoring devices (CGMs). To that end, we analyzed the ambulatory glucose profiles of patients as well as detailed all the modifications in their daily habits, and, simultaneously, compared them with the patient's data previous to the announcement of the state of alarm.

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