ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
STUDY OBJECTIVES: To examine associations among instructional approaches, school start times, and sleep during the COVID-19 pandemic in a large, nationwide sample of U.S. adolescents. METHODS: Cross-sectional, anonymous self-report survey study of a community-dwelling sample of adolescents (grades 6-12), recruited through social media outlets in October/November 2020. Participants reported on instructional approach (in-person, online/synchronous, online/asynchronous) for each weekday (past week), school start times (in-person or online/synchronous days), and bedtimes (BT) and wake times (WT) for each identified school type and weekends/no school days. Sleep opportunity was calculated as BT-to-WT interval. Night-to-night sleep variability was calculated with mean square successive differences. RESULTS: Respondents included 5,245 racially and geographically diverse students (~50% female). BT and WT were earliest for in-person instruction; followed by online/synchronous days. Sleep opportunity was longer on individual nights students did not have scheduled instruction (>1.5 h longer for online/asynchronous than in-person). More students obtained sufficient sleep with later school start times. However, even with the same start times, more students with online/synchronous instruction obtained sufficient sleep than in-person instruction. Significantly greater night-to-night variability in sleep-wake patterns was observed for students with in-person hybrid schedules versus students with online/synchronous + asynchronous schedules. CONCLUSIONS: These findings provide important insights regarding the association between instructional approach and school start times on the timing, amount, and variability of sleep in U.S. adolescents. Given the public health consequences of short and variable sleep in adolescents, results may be useful for education and health policy decision-making for post-pandemic secondary schools.