School-Day Routines Positively Impact Time in Range for Children with Type 1 Diabetes

The impact of school day routines on glycemic control in children is unclear. We compared continuous glucose monitor (CGM) metrics for youth with type 1 diabetes during weekday school hours (8AM-3PM) between two 4-week periods before and during the COVID-pandemic, when children had transitioned to virtual school. Youth with >70% CGM wear (n=209) were included;46% male, mean±SD age 10.6±1.5 years, hemoglobin A1c 7.5±0.8%, 64% on insulin pumps. Time in range (TIR, 80-180 mg/dL) was similar during the pandemic (51.6±24.1%) compared to pre-pandemic (50.8±23.3%) . Using random coefficient multilevel linear mixed models, younger age (p=0.025) and pump use (p=0.043) predicted TIR, but not race (p=0.76) , diabetes duration (p=0.07) , body mass index (p=0.54) , or insurance status (p=0.45) . TIR pre- vs. during the pandemic varied significantly by time of day (p<0.001) . With in-person school pre-pandemic, TIR increased over school hours;with virtual school during the pandemic, TIR decreased in the morning and then remained steady (Figure) . Time above range (TAR, >180 mg/dL) had the opposite pattern. These findings suggest that in-person school can contribute to better TIR and lower TAR. Possible explanations include classroom and physical activity routines, plus school nurse support. During virtual school, continued routines are important and interventions to optimize diabetes care in school may benefit glycemic control.

Implications of the School Day on Health Behaviors for Children With Type 1 Diabetes: A Survey of Parent Perspectives During the COVID-19 Pandemic.

PURPOSE: The purpose of this study is to survey parents of youth with type 1 diabetes during the COVID-19 pandemic with school closures to better understand the implications of the school day on health care behaviors. METHODS: A cross-sectional, online survey was distributed to parents of youth with type 1 diabetes ≤19 years of age in a large, academic diabetes center. Questions encompassed perceived changes in management behaviors and plans for return to school. Subgroup analysis compared parent responses by child's age, reported stressors, and socioeconomic markers. RESULTS: Parents reported a worsening in their child's diabetes health behaviors during school closures compared to what they perceived during a regular school day before the pandemic. More than half of parents reported feeling that their child was unable to maintain a normal routine, with particular implications for snacking between meals, daily physical activity, and sleep habits. Families with adolescents or those experiencing multiple pandemic-related stressors reported greater challenges. In open-ended responses, families highlighted difficulty in balancing school, work, and diabetes care and expressed concerns about the mental health repercussions of school closures for their children. Nearly half of parents reported being at least moderately worried about return to school, whereas only a minority reported seeking guidance from their diabetes provider. CONCLUSIONS: Parent-reported disruptions of school-day routines frequently had adverse consequences for diabetes management in this population. These findings highlight the importance of a school-day routine for children with type 1 diabetes; during closures, families may benefit from mitigating strategies to maintain effective habits.

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.