Glucose decreases in type 1 diabetes cohort during Spain’s COVID-19 lockdown
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A cohort of adults with type 1 diabetes in Spain had a decrease in mean glucose during the country’s COVID-19 lockdown, with about 17% of the group having clinically meaningful glycemic improvement, according to study data.
“This study confirms that glycemic control based on continuous glucose monitoring metrics in adults with type 1 diabetes significantly improved during lockdown due to the COVID-19 pandemic and maintained over time for at least 2 months during de-escalation,” Oscar Moreno-Dominguez, MD, an endocrinologist in the division of diabetes, department of endocrinology and nutrition at Hospital Universitario La Paz Madrid, Spain, and colleagues wrote in a study published in Diabetes Technology & Therapeutics. “These results may support that having more time for self-management, along with the regularity of daily schedules, the type of food and physical activity, allow improving and maintaining glycemic control in patients with type 1 diabetes even 2 months after lockdown.”
Moreno-Dominguez and colleagues analyzed data from 138 adults with type 1 diabetes (mean age, 42.5 years; 64.5% women) who used a FreeStyle Libre (Abbott) during Spain’s COVID-19 lockdown. All participants had used CGM for at least 6 months and used the LibreView platform to share data and CGM use at least 70% of the time.
Data was analyzed during three time periods. Pre-lockdown data were collected from Feb. 21 to March 5. Data from the lockdown were taken from March 16 to March 29 and came from a period when individuals were prohibited from leaving home except for essential work and activities. Data from 2 weeks of de-escalation in which nonessential work and activities were allowed during certain times were collected from May 14 to May 27.
During the lockdown, participants had a lower mean glucose (149 mg/dL vs. 155.5 mg/dL; P < .001), a lower glucose management indicator (6.87% vs. 7.03%; P < .001) and a decrease in time above range (27% vs. 30.7%; P < .001) compared with before the lockdown.
After the lockdown, the group had further reductions in mean glucose (145.6 mg/dL), glucose management indicator (6.8%) and time above range (24.7%). Participants also had an increase in CGM use (96.2% vs. 94.7%; P = .021) and scans per day (12.6 vs. 11.6; P = .04) compared with before the lockdown.
Of the study population, 17.4% had a clinically meaningful glycemic improvement during the lockdown. Those with glycemic improvement had a higher last laboratory HbA1c value (7.5%) compared with those who did not have glycemic improvement (7.1%; P = .041), but there were no other differences between the groups. Those who had continuous subcutaneous insulin infusion therapy (adjusted OR = 3.77; 95% CI, 1.29-10.97; P = .015) and a higher last laboratory HbA1c (aOR = 1.96; 95% CI, 1.15-3.34; P = .014) were more likely to have glycemic improvement, whereas those with a shorter diabetes duration (aOR = 0.96; 95% CI, 0.91-0.998; P = .039) were less likely to have glycemic improvement.
“Although similar data has been reported, this study consists of the largest sample of patients analyzed during the three periods mentioned and demonstrates the existence of clinical variables (continuous subcutaneous insulin infusion therapy, poor prior glycemic control and shorter diabetes duration) that are associated with a better glycemic control during lockdown,” the researchers wrote.
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