ABSTRACT
AimsThe COVID-19 pandemic impacted the daily routine of children by the introduction of remote learning and telemedicine. The impact of these changes is unclear in the management of type 1 diabetes in children. The aim of this study was to evaluate the impact of several lockdowns on glycaemic control in children and adolescents with type 1 diabetes in a large paediatric hospital in the UK.MethodsThis retrospective observational cohort study reviewed real world data from patients with type 1 diabetes who used glucose monitoring devices including continuous glucose monitors, flash glucose monitors or self-monitoring of blood glucose. Data was collected from four timeframes matching the dates of lockdown restrictions in the UK, T1 - 5/11/2019 to 23/3/2020, T2 - 24/3/2020 to 8/8/2020, T3 - 5/11/2020 to 23/3/2021 and T4 - 24/3/2021 to 8/8/2021. Time in Range (TIR), Mean blood sugar and standard deviation (SD) of blood sugar readings were compared across all four timeframes using paired T-tests.ResultsA total of 243 children (128 male and 115 female) were included in the study with a mean age of 14.2 ± 3.71 (standard deviation) years old. The median duration of T1D was 6.15 years (IQR 4.25-8.68). There was an increase in percentage TIR between T2 vs T4(56.8% vs 57.8%, p = 0.037) and improved glucose variability, as shown by SD between T1 vs T2 (4.57 mmol/L vs 4.44 mmol/L, p = 0.0014), T2 vs T4 (4.44 mmol/L vs 4.41 mmol/L, p = 0.0028) and T3 vs T4 (4.42 mmol/L vs 4.41 mmol/L, p = 0.027).ConclusionGlycaemic control did not decline in children and adolescents with T1D as a result of the COVID-19 pandemic, rather%TIR and SD of blood glucose showed improvement across a series of the three UK lockdowns. Enthusiasm to revert back from telemedicine following the pandemic should be tempered by our findings that remote management has not been detrimental to glycaemic control.
ABSTRACT
In emergency situations like the coronavirus pandemic, decisions must be made quickly, with only partial information. But good decisions are still possible using risk-benefit analysis. By Peter J. Diggle, Tim Gowers, Frank Kelly and Neil Lawrence.
ABSTRACT
Introduction: The coronavirus disease global pandemic led to national lockdown in the United Kingdom on 23rd March 2020. We compared the glycaemic control of children and adolescents with Type 1 diabetes (T1DM) at Doncaster &Bassetlaw Teaching Hospitals in the 12 weeks prior to the lockdown, to the 12 weeks following lockdown. Methods: HbA1c result 3 months following lockdown was compared to the last HbA1C prior to lockdown. Data from Continuous Glucose Monitors (CGMs), Flash Glucose Systems (FGS) and those performing Self-Monitoring of Blood Glucose (SMBG) were compared alongside changes to patient contact that occurred. Results: In 264 patients under 20 years of age across both hospitals in the Trust, face-to-face consultations decreased (245 vs 151, 39%), and remote consultations increased (1751 vs 2269, 30%) (χ 2 p<0.001). Excluding those within a year of diagnosis, 122 had paired HbA1c results, and 80 had more than 70% of glucose monitoring data available. HbA1c levels decreased (67.4 mmol/mol vs 61.3 mmol/mol, p<0.001) and glucose monitoring data showed lower mean glucose after lockdown (9.7mmol/L vs 9.5mmol/L, p=0.034) with lower standard deviation (4.4mmol/L vs 4.2mmol/L, p<0.001). Proportion of time in range (3.9mmol/L to 10mmol/L) increased (n=47, 55.2% vs 58.0%, p=0.017), with no change to time below range (4.8% vs 5.0%, p=0.495). Conclusion: Glycaemic control improved in the 12 weeks following national lockdown. This demonstrates the difficulties faced by patients and carers managing T1DM around school pressures, meals away from home, social life and peer pressure. Increased remote contact with patients with T1DM has not been detrimental to glycaemic control.