Abstract
ImportanceThere is no consensus on the impact of the 2020 COVID-19 pandemic lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) in the US.AimTo determine the impact of the pandemic lockdown of March 15th through July 6th, 2020 on glycemic control after controlling for confounders.Subjects and MethodsAn observational study of 110 subjects of mean age 14.8 ± 4.9 years(y), [male 15.4 ± 4.0y, (n=57); female 14.1 ± 3.8y, (n=53), p=0.07] with T1D of 6.31 ± 4.3y (95% CI 1.0-19.7y). Data were collected at 1-4 months before the lockdown and 1-4 months following the lifting of the lockdown at their first post-lockdown clinic visit.ResultsThere was no significant change in A1c between the pre- and post-pandemic lockdown periods, 0.18 ± 1.2%, (95% CI -0.05 to 0.41), p=0.13. There were equally no significant differences in A1c between the male and female subjects, -0.16 ± 1.2 vs -0.19 ± 1.2%, p=0.8; insulin pump users and non-pump users, -0.25 ± 1.0 vs -0.12 ± 1.4%, p=0.5; and pubertal vs prepubertal subjects, 0.18 ± 1.3 vs -0.11 ± 0.3%, p=0.6. The significant predictors of decrease in A1c were pre-lockdown A1c (p<0.0001) and the use of CGM (p=0.019). The CGM users had significant reductions in point-of-care A1c (0.4 ± 0.6%, p=0.0012), the CGM-estimated A1c (p=0.0076), mean glucose concentration (p=0.022), a significant increase in sensor usage (p=0.012), with no change in total daily dose of insulin (TDDI). The non-CGM users had significantly increased TDDI (p<0.0001) but no change in HbA1c, 0.06 ± 1.8%, p=0.86.ConclusionsThere was no change in glycemic control during the pandemic lockdown of 2020 in US children.
Highlights
The emergence of the global COVID-19 pandemic in 2019 triggered strict lockdown measures in various parts of the world to prevent the spread of the causative agent, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), leading to the restriction of movement and quarantining of individuals who either had the infection or were at risk for the disease
There was no change in glycemic control during the pandemic lockdown of 2020 in US children
With the lifting of the initial lockdown measures, it has become necessary to assess the medium to long-term impact of the pandemic lockdown on glycemic control in children and adolescents with type 1 diabetes as a way of providing a historical context to the present pandemic and generating information to address diabetes care in future occurrences
Summary
The emergence of the global COVID-19 pandemic in 2019 triggered strict lockdown measures in various parts of the world to prevent the spread of the causative agent, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), leading to the restriction of movement and quarantining of individuals who either had the infection or were at risk for the disease. These measures severely interrupted the delivery of health care services to individuals with acute and chronic diseases such as type 1 diabetes (T1D). Interactions between children and adolescents with type 1 diabetes and their caregivers occurred mostly through telehealth services and phone calls by nurses and physicians
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