Glycemic goals improve for children with type 1 diabetes during UK COVID-19 lockdown
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Children in the U.K. with type 1 diabetes saw decreases in HbA1c and mean blood glucose levels after the country’s COVID-19 lockdown began compared with before, according to data presented at the ENDO annual meeting.
“This is the first study published with this data in children and young people,” Neil Lawrence, BEng, MBChB, a pediatrics trainee at Sheffield Children’s Hospital NHS Foundation Trust, and NIHR academic clinical fellow at the University of Sheffield, told Healio. “Studies in developed countries such as Scotland, Italy and Spain have shown a similar effect in adults. Findings in India were that glycemic control was worse during lockdown, but there was a notable national shortage of glucose testing strips in India during this time.”
Lawrence and colleagues analyzed data from glucose monitoring devices used by children with type 1 diabetes who were patients at Doncaster and Bassetlaw Teaching Hospitals. All children had type 1 diabetes for at least 1 year. Data from a 12-week period from Dec. 30, 2019, to March 22, 2020, were used for the pre-lockdown period, whereas the post-lockdown data were collected from March 30 to June 21, 2020. HbA1c and mean glucose level were the primary outcomes in the study, and standard deviation and proportion of time spent in range were secondary outcomes.
There were 80 children included in the study (median age, 13.6 years), of whom 23 used a continuous glucose monitor, 24 used a flash glucose system and 33 performed self-monitoring blood glucose.
The study cohort had a decrease in HbA1c from 67.4 mmol/mol (8.3%) during the pre-lockdown period to 61.3 mmol/mol (7.8%) after the lockdown (P < .001). Mean blood glucose level also decreased for participants, from 9.7 mmol/L before the lockdown to 9.5 mmol/L after the lockdown (P = .044). The mean standard deviation of blood glucose decreased from 4.4 mmol/L before the lockdown to 4.1 mmol/L post-lockdown (P < .001). Participants also increased their time in range from before the lockdown to after (55.2% vs. 58%; P = .017).
The improvement in glycemic control was observed even with a decrease of in-person visits. The number of phone and video contacts with patients in the study cohort increased from 1,751 before the lockdown to 2,269 after the lockdown, whereas the number of face-to-face patient contacts decreased from 245 before the lockdown to 151 after the lockdown.
“People were worried that an increase in remote consultations by video and phone and a reduction of face-to-face appointments would make glycemic control worse,” Lawrence said. “There was no evidence of this, and future practice should reflect more flexibility around how patients and families attend their appointments.”
Lawrence said the findings are a testament to the difficulties children with type 1 diabetes face when they are not at home, and providers should focus on improving diabetes management outside of the home.
“This shows the importance of dealing with behavior when managing type 1 diabetes,” Lawrence said. “Education of patients and families should be based around this.”
Lawrence said an analysis of data from the U.K.’s second lockdown is underway, and he hopes that the data will add more clarity into whether these findings were due more to the pandemic or the closing of schools.
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Lawrence N, et al. Impact of COVID-19 national lockdown on glycemic control in children and adolescents with type 1 diabetes (T1DM): A retrospective review at a large UK teaching hospital. Presented at: Endocrine Society Annual Meeting; March 20-23, 2021 (virtual meeting).
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