Metrics improve for US children with type 1 diabetes using CGM in first year of COVID-19
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A cohort of U.S. children with type 1 diabetes had a decrease in mean glucose level and glucose management indicator during the first year of the COVID-19 pandemic compared with the prior year, according to study data.
In a retrospective review of electronic health records of children with type 1 diabetes, there was a decrease in mean HbA1c and increase in clinic visits attended during the COVID-19 pandemic compared with the same period a year prior, with more than 90% of visits conducted virtually.
“Maintaining glucose levels below the HbA1c target of 7% is associated with better long-term health in people with type 1 diabetes,” Tara Kaushal, MD, MSHP, staff endocrinologist in the pediatric, adolescent and young adults section, and research associate in the section on clinical, behavioral and outcomes research at Joslin Diabetes Center, told Healio. “The finding that more youth were able to achieve the continuous glucose monitoring equivalent of this target despite the changes in lifestyle and stress of this highly unusual pandemic year is encouraging.”
Kaushal and colleagues analyzed data from patients aged 1 to 17 years with type 1 diabetes who were actively using CGM. Participants had a diabetes duration of at least 6 months if they were younger than 6 years, or 1 year if they were aged at least 6 years. Data from before the pandemic were collected from April 2019 to March 15, 2020, and data from April 2020 to March 15, 2021, were used for the pandemic period. Researchers extracted mean and standard deviation glucose, coefficient of variation, HbA1c and the number and type of visits from health records, and glucose management indicator (GMI) was calculated for each participant.
The findings were published in Diabetes Technology & Therapeutics.
Pre-pandemic data were available for 641 participants (52% girls; mean age, 12.3 years; mean diabetes duration 6 years), and 648 (52% girls; mean age 13.3 years; mean diabetes duration 6.7 years) had data from during the pandemic; 555 had data available for both periods.
The mean number of visits per person increased from 2.7 before the pandemic to 3.1 during the pandemic. The percentage of virtual visits increased from 0.1% pre-pandemic to 93.5% during the pandemic.
Mean glucose decreased from 193.6 mg/dL before to 187.3 mg/dL during the pandemic (P = .001). There were also decreases in standard deviation glucose and coefficient of variation.
GMI decreased slightly from 7.9% before COVID-19 to 7.8% during the pandemic (P = .002). During the pre-pandemic period, 10% of participants had a GMI less than 7%. That proportion increased to 18% during COVID-19. The percentage of participants with a GMI of 9% or higher decreased from 10% to 8% during the pandemic.
The number of mean HbA1c values available per patient dropped from 3.5 pre-pandemic to 1.2 during the pandemic; about two-thirds of participants had no HbA1c values available during the pandemic period. Mean HbA1c declined from 8.1% to 7.7% during the pandemic (P = .001).
Kaushal said there are opportunities to perform additional research to better understand causal factors for the improvement in glycemia.
“There may have been increased parental oversight and flexibility in schedules allowing for more attention to diabetes care,” Kaushal said. “Telemedicine may have allowed for increased touchpoints leading to more diabetes support. Further research can help better understand these associations. This study captures only CGM users. While the majority of the patients in our clinic use CGM, there may be differences in patterns of glycemic control before and during the pandemic in those who do not use this technology. There are recognized disparities in technology use and glycemic control in type 1 diabetes that also warrant further studies in the context of the pandemic.”
For more information:
Tara Kaushal, MD, MSHP, can be reached at tara.kaushal@joslin.harvard.edu.
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