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Lessons learned from the continuous glucose monitoring metrics in pediatric patients with type 1 diabetes under COVID-19 lockdown

Authors
  • Brener, Avivit1, 2
  • Mazor-Aronovitch, Kineret2, 3, 4
  • Rachmiel, Marianna2, 5
  • Levek, Noa4
  • Barash, Galia2, 5
  • Pinhas-Hamiel, Orit2, 3, 4
  • Lebenthal, Yael1, 2
  • Landau, Zohar4, 6, 7
  • 1 Tel Aviv Sourasky Medical Center,
  • 2 Tel Aviv University,
  • 3 Chaim Sheba Medical Center,
  • 4 Maccabi Health Care Services,
  • 5 Shamir (Assaf Harofeh) Medical Center,
  • 6 Barzilai Medical Center,
  • 7 Ben-Gurion University of the Negev,
Type
Published Article
Journal
Acta Diabetologica
Publisher
Springer Milan
Publication Date
Oct 07, 2020
Pages
1–7
Identifiers
DOI: 10.1007/s00592-020-01596-4
PMID: 33026497
PMCID: PMC7538839
Source
PubMed Central
Keywords
License
Unknown

Abstract

Aims Billions of people have been under lockdown in an attempt to prevent COVID-19 spread. Lifestyle changes during lockdown could lead to deterioration of glycemic control in type 1 diabetes (T1D). We aimed to assess the impact of COVID-19 lockdown on the glycemic control of pediatric patients with T1D. Methods This observational real-life study from the AWeSoMe Group assessed continuous glucose monitoring (CGM) metrics of 102 T1D patients (52.9% males, mean age 11.2 ± 3.8 years, mean diabetes duration 4.2 ± 3.8 years) who used  Dexcom G5. The data were accessed without any interface between patients, caregivers, and the diabetes team. Study variables from CGM metrics were: mean glucose level, time-in-range (TIR, 70–180 mg/dL; 3.9–10 mmol/L), hypoglycemia (< 54 mg/dL; < 3 mmol/L), hyperglycemia (> 250 mg/dL; > 13.3 mmol/L), coefficient of variation (CV), and time CGM active before and during lockdown. Delta-variable = lockdown variable minus before-lockdown variable. Results The mean TIR was 60.9 ± 14.3% before lockdown, with no significant change during lockdown (delta-TIR was 0.9 ± 7.9%). TIR during lockdown was significantly correlated with TIR before lockdown ( r = 0.855, P < 0.001). Patients with improved TIR (delta-TIR > 3%) were significantly older than patients with stable or worse TIR ( P = 0.028). Children aged < 10 years had a significantly higher CV before lockdown and during lockdown than children aged ≥ 10 years ( P = 0.02 and P = 0.005, respectively). Among children aged < 10 years, a multiple linear regression model revealed associations of age and lower socioeconomic cluster with delta-TIR ( F = 4.416, P = 0.019) and with delta-mean glucose ( F = 4.459, P = 0.018). Conclusions CGM metrics in pediatric patients with T1D were relatively stable during a nationwide lockdown. Intervention plans should focus on younger patients with lower socioeconomic position.

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