Effects of the COVID-19 Pandemic on Type 1 Diabetes Outcomes

As the COVID-19 pandemic has disrupted daily life, it is important to understand its effects on youth with T1D. The COVID-19 Exposure and Family Impact Survey (CEFIS) was used to examine COVID-19 effects on diabetes metrics in a pediatric T1D population. Parents of youth with T1D (n=108;mean age 11.6±4 yrs, mean T1D duration 5.3±3.9yrs, 57.4% male) completed the CEFIS (score ranges: Exposure 0-25, Impact 0-4 with >2.5 indicating negative impact, and Distress 1-10) . CEFIS measures and diabetes metrics (A1c, average glucose, in-person visits vs. telemedicine, and number of cancelled visits) were obtained at baseline, 3, 6, 9, and 12 months. Changes in diabetes metrics and correlations with CEFIS scores were analyzed by anova. Cancelled visit frequency per person decreased from baseline to 3 months and was maintained for the duration of the study (p<0.001) . For every one point increase in CEFIS Impact, A1c increased by 0.3 (0.1%) (p=0.04) . For every one point increase in CEFIS Exposure, average glucose increased by 2.3 (0.7mg/dL) (p=0.002) . High perceived stress from the COVID-19 pandemic from CEFIS Impact and Exposure scores may worsen glycemic outcomes for youth, suggesting that the pandemic had a negative affect regardless of COVID-19 infection. Further studies on perceived stress and effects on diabetes management are needed to determine long term impacts of the COVID-19 pandemic on this population.

Impact of the COVID-19 Pandemic on Quality of Life in Youth with Type 1 Diabetes

Diabetes is a risk factor for COVID-19 infection-related complications, increasing fear in this population. The effect of the pandemic on quality of life for youth with type 1 diabetes (T1D) has not been evaluated. Youth with T1D (n=108, mean age 11.6±4.0 yrs, mean T1D duration 5.3±3.9, 57.4% male) and a parent completed surveys at baseline (September to November 2020) and every 3 months for 12 months. Measures included the COVID-19 Exposure and Family Impact Survey ([CEFIS], exposure (range 0-25) , family impact (range 0-4, scores >2.5 indicate negative impact) , distress (range 1-10)) , the PedsQL Diabetes Module (higher score indicates higher quality of life) , and the PROMIS Sleep Disturbance and Sleep-Related Impairment surveys (higher score indicates more problems) . CEFIS impact score remained above 2.5 over 12 months. Parent Proxy PedsQL decreased from 3 to 6 months (p=0.019) and 3 to 12 months (p=0.017) . Parent Proxy PROMIS Sleep-Related Impairment increased from 6 to 12 months (p=0.03) and 9 to 12 months (p=0.004) . PedsQL (parent and child) significantly decreased with increased exposure (p<0.001 and p=0.011) and impact (p<0.001 and p=0.016) . Families of youth with T1D were negatively impacted by the pandemic. Parents reported worsening child quality of life and sleep-related impairment during this time. As the pandemic continues, it is important for health care providers to be mindful of mental health in youth with T1D.

The future of telehealth in type 1 diabetes.

PURPOSE OF REVIEW: Although telemedicine and telehealth services have been a part of type 1 diabetes (T1D) clinical care for several decades, the expansion of in-home telemedicine during the COVID-19 pandemic significantly increased interest in long-term use as part of routine care. This review highlights the current literature regarding telemedicine in T1D care as well as the benefits and barriers to use in a postpandemic world. RECENT FINDINGS: Telemedicine has increased patient contact with healthcare providers, allowing for more frequent insulin dose adjustments and improvements in glycemic outcomes. In addition to routine clinical care, T1D device training and mental healthcare have been successful through telemedicine. Significant barriers to continued telemedicine care exist, including patient access and technology knowledge, language, and loss of face-to-face interaction. Healthcare providers additionally face unpredictable reimbursement and loss of continuity across state lines, and lack of resources and training for device downloads and telemedicine software. SUMMARY: Telemedicine can be successfully used in T1D care and has the potential to significantly impact glycemic and long-term outcomes. Due to continued interest for in-person visits by people with T1D and providers, it is likely that long-term telemedicine use will include a hybrid format.

Diabetes Technology Use in Remote Pediatric Patients with Type 1 Diabetes Using Clinic-to-Clinic Telemedicine.

Background: Clinic-to-clinic telemedicine can increase visit frequency in pediatric patients with type 1 diabetes (T1D) living far from a diabetes specialty clinic, but the impact on adoption of diabetes technology is unclear. Materials and Methods: Pediatric patients with T1D in Colorado and surrounding states who received diabetes care using clinic-to-clinic telemedicine were enrolled. Medical records and surveys were reviewed to ascertain technology use, and data were compared to patients from the main clinic population. Results: Patients (N = 128, baseline mean age 12.4 ± 4.2 years, median T1D duration 3.3 years [IQR 1.4-7.7], mean A1c 8.9% ± 1.8%, 60% male, 75% non-Hispanic white, 77% private insurance) who utilized telemedicine were included. Technology use among telemedicine patients was not associated with gender, T1D duration, insurance, distance from the main clinic or rural designation but was associated with ethnicity and A1c. Compared to the main clinic cohort (N = 3636), continuous glucose monitor (CGM) use and pump/CGM combination use was lower among patients participating in clinic-to-clinic telemedicine (CGM: 29.7% vs. 56.0%, P < 0.001; CGM/pump combination: 27.3% vs. 40.3%, P = 0.004). Technology use was associated with lower A1c regardless of cohort. Conclusions: Compared to patients attending in-person clinic, pediatric T1D patients who use clinic-to-clinic telemedicine due to their distance from the main clinic, have lower CGM and combination CGM/pump use. For both telemedicine and main clinic patients, CGM and CGM/pump combination was associated with lower A1c. Additional research is needed to explore reasons for this discrepancy and find methods to improve CGM use in this population.

Family Exposure and Impact of COVID-19 on a Pediatric T1D Population

The COVID-19 pandemic resulted in unprecedented changes in day-to-day life. In families of youth with type 1 diabetes (T1D), preliminary studies suggest impacts on physical/mental health and diabetes self-management. The COVID-19 Exposure and Family Impact Survey (CEFIS) assesses the impact of the pandemic. Parents of youth with T1D (mean age 11.6 yrs, mean T1D duration 5.3 yrs, 57.4% male) completed the CEFIS. Outcomes include exposure (range 0-25), family impact (range 0-4, scores >2.5 indicate negative impact), and distress (range 1-10). Data were collected at baseline (Sept to Nov 2020) and 3-month follow-up (Dec 2020 to Feb 2021). Exposure scores were relatively low (baseline 7.63±2.56, 3-months 7.50±2.93), however, a negative impact on families was reported at baseline (2.74±0.57) and 3-months (2.71±0.60). Distress was present at baseline and 3-months (range 4.26±2.03 to 4.86±2.05). There were no significant group differences when stratifying baseline scores by age or T1D duration. Despite relatively low exposure, COVID-19 had a negative impact on families of youth with T1D. Similar family impact and distress scores at baseline and 3-months highlight the enduring impact of the pandemic on families almost a year into the pandemic. Additional information is needed on how COVID-19 has impacted T1D management. However, clinicians need to be mindful of the significant distress families may be experiencing as a result of the pandemic.