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: The COVID-19 pandemic imposed a heavy burden on the healthcare systems worldwide, especially during initial outbreaks. The strain on medical systems, including human resources, as well as shift to telemedicine and pro-isolation policy may have delayed diagnosis and aggravated the outcomes of type 1 diabetes (T1D) in children, possibly increasing the incidence of diabetic ketoacidosis (DKA) at diabetes onset. Objectives: Compare the incidence of T1D in children and fraction of new T1D cases presenting with DKA among multiple pediatric diabetes care centres in Poland between a year before COVID-19 pandemic outbreak and after. Methods: We contacted 14 reference pediatric diabetes centres in Poland, which collectively provide diabetes care for a population of 6.2 MLN children. They were asked to provide a case-by case data concerning new cases of T1D diagnosed between 15th March 2019 and 15th Match 2021 in children <18 y.o., together with available clinical information. Collected data were divided into two year-long periods - before COVID-19 pandemic outbreak and after, with the division made on March 15 2020, when policy changes and lockdown was imposed. In addition, demographic data for each studied region was downloaded from central statistical office for years 2019 and 2020. Results: In the assessed period, we noted 2942 new cases of T1D (overall incidence rate 23.6 per 100000 patient-years) amongst 12 Poland regions (19.9 - 27.1), with a significant increase between pre-COVID- 19 and COVID-19 period across all regions (mean increase 4.8±4.2 per 100000, p=0.0002). Among new T1D cases, 1409 (47.9%) presented with DKA (38.8 to 72.1%). The first wave of COVID-19 was associated with a significant increase in fraction of DKA at T1D diagnosis across all regions (mean +8.4±10.5%, p=0.0175). Greatest increase was noted during the first 3 months after lockdown. Conclusions: In a multicentre national perspective, COVID-19 outbreak and related restrictions were associated with increased incidence of DKA at T1D presentation.
ABSTRACT
Introduction: The first wave of COVID-19 pandemic had a great impact on management of many chronic diseases, however, its effect on type 1 diabetes (T1D) has been clear Objectives: This study attempted to evaluate the glucose control in children and adolescents with T1D during the first wave of COVID-19 pandemic. We focused on three periods in relative to state-imposed restrictions: before, during and after lockdown. Moreover, we assessed the parent's perspective on telehealth care in that period. Methods: This was an observational, single-centre study. We included patients aged 1-18 treated using both insulin pumps and continuous glucose monitoring (CGM). Data from CGM were collected retrospectively and processed by software to calculate parameters of glycemic variability. In the analysis we included the most complete 30 days of the 2-months periods before, during, and after lockdown. The parents of patients completed a questionnaire regarding the impact of lockdown on T1D treatment as well as satisfaction with telehealth care. Results: We included 86 patients [median age 11.52 (9.31-14.41) years, T1D duration 3.34 (1.75-5.12) years, yearly-averaged HbA1c 6.94% (6.33-7.45)]. Only coefficient of variation changed significantly over time (p=0.0213), decreasing during the lockdown [median change vs baseline -2% (-8% - 3%), post-hoc p<0.05], and slightly increasing afterwards [1% (-1% - 3%), post-hoc p>0.05]. Mean glucose, TBR<70, TIR70-180, TAR>180 did not change significantly, with mean TIR remaining between 73 and 75% across all timepoints. 47.67% of parents reported increased stress related to caring for their child. However, minority encountered difficulties with childcare (30.23%). Most parents were positive about telehealth care. Conclusions: In our group, glucose control of T1D did not deteriorate over the analyzed time, despite increased stress and in some cases difficulties in providing care for a child with T1D. Parents also appreciated the physician's extensive assistance in treating T1D.
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).