Abstract
AimsThe majority of studies report that the Covid-19 pandemic lockdown did not have a detrimental effect on glycaemia. We sought to explore the impact of lockdown on glycaemia and whether this is sustained following easing of restrictions.MethodsRetrospective, observational analysis in adults and children with type 1 diabetes attending a UK specialist centre, using real-time or intermittently scanned continuous glucose monitoring. Data from the following 28-day time periods were collected: (i) pre-lockdown; (ii) during lockdown; (iii) immediately after lockdown; and (iv) a month following relaxation of restrictions (coinciding with Government-subsidised restaurant food). Data were analysed for times in glycaemic ranges and are expressed as median (IQR).Results145 adults aged 35.5 (25.8–51.3) years with diabetes duration of 19.0 (7.0–29.0) years on multiple daily injections of insulin (60%) and continuous insulin infusion (40%) were included. In adults, % time in range (70-180mg/dL) increased during lockdown (60.2 (45.2–69.3)%) compared to pre-lockdown (56.7 (43.5–65.3)%; p<0.001). This was maintained in the post-lockdown time periods. Similarly, % time above range (>180mg/dL) reduced in lockdown compared to pre-lockdown (p = 0.01), which was sustained thereafter. In children, no significant changes to glycaemia were observed during lockdown. In multivariable analysis, a greater increase in %TIR 3.9-10mmol/L (70-180mg/dL) during lockdown was associated with higher levels of deprivation (coefficient: 4.208, 95% CI 0.588 to 7.828; p = 0.02).ConclusionsGlycaemia in adults improved during lockdown, with people from more deprived areas most likely to benefit. This effect was sustained after easing of restrictions, with government-subsidised restaurant eating having no adverse impact on glycaemia.
Highlights
The coronavirus disease (COVID-19) outbreak caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was defined by the World Health Organisation as a global pandemic on 11th March 2020 [1]
A greater increase in %time in range (TIR) 3.9-10mmol/L (70-180mg/dL) during lockdown was associated with higher levels of deprivation
Glycaemia in adults improved during lockdown, with people from more deprived areas most likely to benefit
Summary
The coronavirus disease (COVID-19) outbreak caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was defined by the World Health Organisation as a global pandemic on 11th March 2020 [1]. The UK government imposed a strict lockdown to slow the transmission of SARS-CoV-2 on 23rd March 2020 [2]. Both type 1 and type 2 diabetes are associated with increased mortality in hospitalized patients with COVID-19 [3], with a higher number of deaths in people with type 1 and type 2 diabetes living in the most deprived neighbourhoods compared to those living in the least deprived areas [3]. Among people with diabetes, factors such as hyperglycaemia and obesity are independently associated with COVID-19 mortality [4]. SARS-CoV-2 may adversely affect glucose metabolism both directly by causing beta cell death and indirectly by increasing insulin resistance [5]. Type 1 diabetes (T1D) self-management can be challenging, involving multiple daily injections of insulin (MDI) or continuous subcutaneous insulin infusion (CSII), guided by selfmonitoring of glucose [6]
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