ABSTRACT
Background and Aims: Despite advances in CGM technology, most studies rely on industry support, making multi-manufacturer analyses difficult. Here, using a new open-access CGM benchmarking platform - GlyCulator 3.0, we analyzed the impact of reimbursement of isCGM (November 2019) and rtCGM (March 2018) in Poland on management of diabetes throughout COVID-19 pandemic. Method(s): The study was performed in a single diabetes center that manages patients aged 0-26 years. Percentage of CGM users who satisfied Time in Range (TIR) criterion (>70% of time glucose levels within 70-180 mg/dl) was calculated for 2019- 2021. To create a uniform benchmark, we selected two weeks from March each year- a period not confounded by countryspecific holidays. CGM files were manually downloaded and included into analysis if provided at least 70% CGM active time in the predefined periods. Glycemic variability metrics were computed using GlyCulator 3.0 (https://glyculator.btm .umed.pl/). Result(s): After download and filtering, 971 periods from 604 patients were included for analysis. The number of isCGM users increased over years 2019-2021 (Chi2 for users over total clinic population, p < 0.0001), for rtCGM users this trend was not significant (p = 0.6066). Percentages of users who met TIR >70% target remained at ~60% for rtCGM and ~40% for isCGM. There was no significant difference in the fraction of patients meeting TIR criteria during the analyzed years (Chi2 for rtCGM p = 0.5279, isCGM p = 0.6038). Conclusion(s): Widespread CGM use allowed us to confirm that the patients' diabetes management was not significantly affected by the COVID-19 pandemic. The GlyCulator 3.0 software allows for fast and reliable CGM benchmarking in similar epidemiological scenarios.
ABSTRACT
Introduction: Diabetes distress (DD) is contributing to psychological burden in children with type 1 diabetes (T1D) and in their parents. DD might be influenced by additional stressors such as COVID-19 pandemic. Objectives: We aimed to compere DD before and during the national COVID-19-related lockdown when schools operated on-line. Methods: Problems Areas in Diabetes-Child (PAID-Ch), Teen (PAID-T) and Parent (P-PAID-Ch, P-PAID-T) questionnaires in paper version were used to evaluate DD before COVID-19 pandemic (November 2019-February 2020). During the lockdown (April 2020) the same surveys were performed by phone. Problem areas covered by PAID questionnaires include: emotional burden, diabetes therapy and regimen-specific burden, family and friends-related distress. During the lockdown parents were additionally asked semi-open questions concerning the impact of the pandemic on diabetes care-related difficulties and worries. Between-group comparisons were performed with Mann-Whitney's U test;changes in each score were assessed with Wilcoxon's test for dependent observations. Results: We enrolled 76 patients (median age [25-75%]: 13.6 [11.8-15.2] years;21 children, 55 adolescents;T1DM duration 3,7 [1.7- 6.8] years). In teens PAID score decreased during the lockdown (-3.0 [-11.0-3.0], p=0.018);evidently in girls (girls vs boys p=0.028). In children (-3.0 [-14.0-7.0], p=0.131) and parents PAID score did not change (teens' parents: 3.0 [-9.0-10.0], p=0.376;children parents: -5.0 [-9.0-1.0], p=0.227). There was a significant difference in PAID score change between children's parents who did not report COVID- 19-related worries (-10.5[-17-(-6)]) compared with those who did report such worries (0 [-7(-8)], p=0.021. Conclusions: COVID-19-related lockdown was associated with decrease in DD in teens with T1D, while no significant change in DD was observed in children or parents. DD decrease in teens during the pandemic should attract attention to the potential “rebound” of DD related to return to regular on-site school routine. (Table Presented).