Time-in-Range (TIR) Is Suboptimal for Youth with Type 1 Diabetes during School

Youth with type 1 diabetes spend half their waking weekday hours at school, yet little is known about glycemic control in school. Continuous glucose monitor (CGM) metrics for youth age 7-12 during school hours (8AM-3PM) were compared between weekdays and weekends for 14 days pre COVID-19. Youth with >70% CGM wear (n=214) were identified from a large academic center: 96% white, 46% male, mean (SD) age 10.6 (1.5) years, duration 3.5 (2.5) years, HbA1c 7.5 (0.8) %, 63% with an insulin pump. For weekday school hours, median TIR (70-180 mg/dL) was 52.4%;only 34 (15%) of youth met a TIR goal of >70%. Using random coefficient multilevel linear mixed models, TIR in school was significantly associated with younger age (p=0.008), shorter duration (p<0.001), and lower HbA1c (p<0.001), but not pump use (p=0.42). Weekday and weekend CGM metrics were clinically similar (Table), though TIR was statistically higher (p<0.001) and time high/very high (>180 mg/dL) lower on weekends (p<0.01). Time exhibited a significant fixed and random effect in mixed models;youth with lower TIR at 8AM tended to have larger improvements over subsequent hours. Notably, TIR early in the school day was nearly half of TIR during similar weekend hours, perhaps relating to sleep/meal schedules. Our data support that TIR in school is sub-optimal but may improve while in school, suggesting a benefit to school day routines and opportunity for improving glycemic control in school.

Gastrointestinal Manifestations of COVID-19: A Review of What We Know.

Background: The coronavirus disease 2019 (COVID-19) is not just a disease of the respiratory system. The virus can affect the gastrointestinal (GI) tract as well. Recognizing the various manifestations in every organ system is important because these manifestations can contribute to community-based transmission. Methods: We outline the evidence of the pathophysiology of COVID-19 in the GI tract, the effects of the virus on the gut and liver, the presence of the virus in stool samples, and the potential for fecal-oral transmission of COVID-19. Most of the literature sources used in this paper are case studies from China following the surge of COVID-19 infection. Results: In patients with COVID-19, GI symptoms such as anorexia, nausea, vomiting, diarrhea, and abdominal pain have presented in conjunction with respiratory symptoms such as fever, shortness of breath, and cough. Evidence also shows acute hepatocellular injury, indicated by elevated liver enzymes such as alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase. Fecal-oral transmission of COVID-19 is suspected because of the presence of COVID-19 RNA in stool samples of COVID-19-positive patients. Conclusion: Even without the presence of respiratory symptoms, several GI symptoms are associated with COVID-19 infection, as well as possible fecal-oral transmission. Therefore, COVID-19 infection should be considered for patients presenting with primarily GI symptoms.