Abstract
BackgroundBetween March 18th and May 13th 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare (i.e. lockdown). Social distancing changed the daily routines of children with type 1 diabetes (T1D). Healthcare professionals were forced to adapt to the pandemic by replacing physical outpatient visits with virtual visits. However, the influence of the lockdown on glycemic control in these patients remained unknown.MethodsIn this retrospective register study from a pediatric diabetes outpatient clinic, we analyzed the glycemic data of T1D patients (n = 245; aged 4 to 16 years) before and under the lockdown. All the participants used continuous glucose monitoring (rtCGM or iCGM), two-thirds were on insulin pumps (CSII), and one-third on multiple daily insulin injections (MDI) therapy.ResultsIn our patient cohort, time in range (TIR, n = 209) and mean glucose levels (n = 214) were similar prior to and under the lockdown (mean change 0.44% [95%CI: -1.1–2.0], p = 0.56 and -0.13 mmol/mol [95%CI: -0.3–0.1], p = 0.17, respectively). However, children treated with CSII improved their glycemic control significantly during the lockdown: TIR improved on average 2.4% [0.6–4.2] (p = 0.010) and mean blood glucose level decreased -0.3 mmol/mol [-0.6-(-0.1)] (p = 0.008). The difference was more pronounced in girls, adolescents and patients using conventional insulin pumps.ConclusionsThe glycemic control in T1D children did not deteriorate under the lockdown, and patients on CSII even improved their control, which suggests that social distancing might have allowed families to use the insulin pump more accurately as out-of-home activities were on hold.
Highlights
Between March 18th and May 13th 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare
There are two studies on predictive low-glucose suspend system (PLGS) in children during COVID-19 with contradictory results: Schiaffini et al showing that 22 children treated with PLGS improved their time – in – range (TIR) [12], whereas Christoforidis et al showing with 34 children on PLGS system, that no difference in the glycemic control was observed during lockdown [3]
Tornese et al demonstrated that glycemic control of T1DM adolescents using hybrid closed-loop (HCL) systems did not worsen during the COVID-19 pandemic and further improved in those who continued physical activity during the quarantine [13]
Summary
Between March 18th and May 13th 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare (i.e. lockdown). The majority of parents followed the recommendation, and only approximately 30% of children participated in daycare during the lockdown [1] Routines such as regular physical activities and psychosocial well-being have an important impact on glycemic control in children with type 1 diabetes (T1D) [2]. There are two studies on predictive low-glucose suspend system (PLGS) in children during COVID-19 with contradictory results: Schiaffini et al showing that 22 children treated with PLGS improved their time – in – range (TIR) [12], whereas Christoforidis et al showing with 34 children on PLGS system, that no difference in the glycemic control was observed during lockdown [3]. Tornese et al demonstrated that glycemic control of T1DM adolescents using hybrid closed-loop (HCL) systems did not worsen during the COVID-19 pandemic and further improved in those who continued physical activity during the quarantine [13]
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