ABSTRACT
Objectives: Lockdown period may have influenced the metabolic control of patients with type 1 diabetes mellitus (T1D) of any age group. The aims of our study were (I) to compare continuous glucose monitoring (CGM)-derived parameters in children, adolescents and adults with T1D before and during lockdown period in Italy and (II) to identify factors potentially contributing to glucose control. Methods: We enrolled 130 consecutive patients with T1D (30 children [1-12 years], 24 adolescents [13-17 years], and 76 adults [>18 years]), using either Dexcom® or FreeStyle Libre® monitoring systems >70% during study period, not wearing hybrid closed loop insulin pump. We calculated several CGM-derived metrics during the 20 days before and the 20 days after lockdown. By phone interview, we retrieved data on adult working activity and performed validated physical activity and perceived stress questionnaires. Results: In children, significantly lower standard deviation of glucose (SDglu) (P = 0.029) and time below range < 54 mg/dL (TBR2) (P = 0.029) were detected after lockdown, when compared to prelockdown. In adolescents, all CGM-derived metrics were comparable between pre- and post-lockdown. In adults, significant improvement of time in range 70-180 mg/dL (TIR) (P < 0.001) and all remaining metrics, apart from % coefficient of variation and TBR2, was detected after lockdown. In adults, considering pre- and post-lockdown changes in SDglu and TIR, we identified a group of patients with improved TIR and SDglu, who has performed more physical activity, a group with improved glucose variability, younger than other patients, and a group with worsened glucose variability, who had higher perceived stress than others. Conclusions: CGM glucose-metrics mostly improved in children and adults with T1D after lockdown, whereas it remained unchanged in adolescents. Age, physical activity, and perceived stress may be relevant factors contributing to metabolic control of T1D in adults.
ABSTRACT
Introduction: On February 202,020, so-called Italian Patient 1 was admitted to the ICU of his local hospital due to a deteriorating clinical condition from SARS-CoV-2/COVID-19 infection. As of June 26th, 239,961 COVID-19 cases have been confirmed in Italy (children = 3805), including deaths (n = 34,708) and who have recovered (n = 187,615). Although children are generally less prone to COVID- 19 and have a milder disease course, children with existing comorbidities could remain at higher risk of complications. Objective: Aim of this study is to document clinical characteristics of children and adolescents with T1D affected with COVID-19. Methods: Starting from the week after lockdown was initiated (March 9th), ISPED started a weekly surveillance for COVID-19 infection on all children with diabetes. Cases with suspected symptoms (n = 1) or children living with positive tested relatives (n = 7), or because hospitalized (n = 3) were undergone to swab test. The surveillance is still ongoing. Results: Eleven patients were diagnosed with COVID-19 (range 6-17 years of age, 7 females);two at T1D onset and nine in patients with established diabetes (diabetes for 1-11 years), all of whom were asymptomatic (n = 7) or had only mild symptoms (n = 4). All had nasopharyngeal swabs positive for SARS-CoV-2 by RT-PCR. Three had mild hyperglycemia, 1 had mild DKA and 2 were admitted for T1D onset, 1 with DKA and 1 without. The remnant children had no disglycemia. Conclusions: In Italy, overall 11 children with T1D had laboratory COVID-19 confirmation. These patients were tested due to having mild COVID-19 symptoms or because they lived close to a known positive patient. These data seem to support the hypothesis that children with T1D are not at higher risk for COVID-19 than general population and have a mild disease course. As the pandemic continues, further work is necessary to assess how this disease affects children and to develop best-evidence-based guidelines for our vulnerable patients.