ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has heavily affected health worldwide, with the various forms of diabetes in children experiencing changes at various levels, including epidemiology, diabetic ketoacidosis rates and medical care. Type 1 diabetes showed an apparent increase in incidence, possibly owing to a direct damage of the virus to the ß-cell. Diabetic ketoacidosis also increased in association with the general fear of referring patients to the hospital. Most children with diabetes (both type 1 and type 2) did not show a worsening in metabolic control during the first lockdown, possibly owing to a more controlled diet by their parents. Glucose sensor and hybrid closed loop pump technology proved to be effective in all patients with type 1 diabetes during the pandemic, especially because the downloading of data allowed for the practice of tele-medicine. Telemedicine has in fact grown around the world and National Health Systems have started to consider it as a routine activity in clinical practice. The present review encompasses all the aspects related to the effects of the pandemic on the different forms of diabetes in children.
ABSTRACT
BACKGROUND AND AIM: Lockdown due to COVID-19 pandemic has forced a decrease in physical activity (PA), an increase in sedentary behavior (SB) and a possibly worsening of fat accumulation in already obese subjects. The aim of this study was to investigate how social restriction may have contributed to weight changes in adolescents with obesity. Secondary aim was to evaluate possible parameters influencing weight changes. METHODS AND RESULTS: Parameters of 51 obese adolescents were compared between two visits: within 2 months before 8 March, start of lockdown, and within 40 days after the end of it. RESULTS: Mean weight gain during lockdown was 2.8 ± 3.7 kg (p < 0.001). Weight increase was higher in males than in females (3.8 ± 3.4 kg vs 1.2 ± 3.7 kg, p = 0.02). The hours dedicated to SB increased (+2.9 ± 2.8 h/day; p < 0.001) while the hours of PA decreased (-1.0 ± 1.6 h/week; p < 0.001). Males spent more hours in SB than females (+3.8 ± 2.7 h/day vs +1.5 ± 2.5 h/day; p = 0.003). There were minor changes in diet during lockdown. The most significant variables influencing both delta BMI and waist/height ratio increase were hours devoted to SB during lockdown and differences in mild and moderate PA before and after lockdown. CONCLUSIONS: Obese adolescents showed a worsening of obesity during lockdown, with males mainly affected, mainly due to a reduced mild PA and increased hours spent in SB.
Subject(s)
COVID-19/prevention & control , Pediatric Obesity/physiopathology , Physical Distancing , Weight Gain , Adolescent , Age Factors , COVID-19/transmission , Child , Diet/adverse effects , Exercise , Female , Humans , Male , Pediatric Obesity/diagnosis , Risk Assessment , Risk Factors , Sedentary Behavior , Sex Factors , Time FactorsABSTRACT
INTRODUCTION: The COVID-19 pandemic forced the Italian government to issue extremely restrictive measures on daily activities since 11 March 2020 ('lockdown'), which may have influenced the metabolic control of type 1 diabetes mellitus (T1D). The aims of the study were to investigate continuous glucose monitoring (CGM) metrics in children and adults with T1D during lockdown and to identify their potentially related factors. RESEARCH DESIGN AND METHODS: We enrolled 130 consecutive patients with T1D (30 children (≤12 years), 24 teenagers (13-17 years), and 76 adults (≥18 years)) using either Dexcom or FreeStyle LibreCGM>70% during the study period, without hybrid closed-loop insulin pump. CGM metrics during the 20 days before and the 20 days after lockdown were calculated. By telephonic contact, we performed validated physical activity and perceived stress questionnaires. RESULTS: In children, significantly lower glucose SD (SDglu) (p=0.029) and time below range (TBR)<54 mg/dL (TBR2) (p=0.029) were detected after lockdown. CGM metrics were comparable in teenagers before and during lockdown. After lockdown, adults improved significantly time in range (TIR) 70-180 mg/dL (p<0.001) and remaining metrics, except percent coefficient of variation and TBR2. In adults, considering the changes in SDglu and TIR occurred before and during lockdown, we identified a group with improved TIR and SDglu who performed more physical activity, one with improved glucose variability who was younger than the other patients, and one with worsened glucose variability who showed higher perceived stress than others. CONCLUSION: In patients with T1D during lockdown, CGM metrics mostly improved in children and adults, whereas it was unchanged in teenagers. In adults, age, physical activity, and perceived stress may be relevant contributing factors.