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2.
BMC Pediatr ; 22(1): 48, 2022 01 19.
Article in English | MEDLINE | ID: covidwho-1633014

ABSTRACT

BACKGROUND: Between March 18th and May 13th 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare (i.e. lockdown). Social distancing changed the daily routines of children with type 1 diabetes (T1D). Healthcare professionals were forced to adapt to the pandemic by replacing physical outpatient visits with virtual visits. However, the influence of the lockdown on glycemic control in these patients remained unknown. METHODS: In this retrospective register study from a pediatric diabetes outpatient clinic, we analyzed the glycemic data of T1D patients (n = 245; aged 4 to 16 years) before and under the lockdown. All the participants used continuous glucose monitoring (rtCGM or iCGM), two-thirds were on insulin pumps (CSII), and one-third on multiple daily insulin injections (MDI) therapy. RESULTS: In our patient cohort, time in range (TIR, n = 209) and mean glucose levels (n = 214) were similar prior to and under the lockdown (mean change 0.44% [95%CI: -1.1-2.0], p = 0.56 and -0.13 mmol/mol [95%CI: -0.3-0.1], p = 0.17, respectively). However, children treated with CSII improved their glycemic control significantly during the lockdown: TIR improved on average 2.4% [0.6-4.2] (p = 0.010) and mean blood glucose level decreased -0.3 mmol/mol [-0.6-(-0.1)] (p = 0.008). The difference was more pronounced in girls, adolescents and patients using conventional insulin pumps. CONCLUSIONS: The glycemic control in T1D children did not deteriorate under the lockdown, and patients on CSII even improved their control, which suggests that social distancing might have allowed families to use the insulin pump more accurately as out-of-home activities were on hold.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adolescent , Blood Glucose , Blood Glucose Self-Monitoring , Child , Communicable Disease Control , Diabetes Mellitus, Type 1/drug therapy , Female , Glycemic Control , Humans , Hypoglycemic Agents/therapeutic use , Pandemics , Retrospective Studies , SARS-CoV-2
3.
Arch Pediatr ; 29(1): 27-29, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1561682

ABSTRACT

AIM: The COVID-19 pandemic has forced governments to impose lockdown policies, thus impacting patients with chronic diseases, such as type 1 diabetes. The aim of this study was to evaluate the impact of lockdown on glycemic control in type 1 diabetes patients. PATIENTS AND METHODS: We retrospectively evaluated patients using a continuous subcutaneous insulin infusion device during the nationwide lockdown. Children and adolescents aged 2-18 years followed up at the Pediatric Endocrinology Unit of Hospitalar São João in Portugal were included in the study. We collected data on the age, weight, insulin doses, and glycemic control of the patients before and after the restrictions. RESULTS: The study included 100 patients, 59 males, with a mean age of 12.5 years. Baseline data showed a suboptimal glycemic control with a median HbA1c of 7.9%. The lockdown was associated with an increase in the body mass index (BMI) of all patients (p = 0.009), particularly girls and older teenagers. Metabolic control deteriorated in the 10-13 age group (p = 0.03), with a 0.4% increase in HbA1c. CONCLUSION: To date, this is the largest study on the impact of lockdown on type 1 diabetes in patients using an insulin pump. The results highlight the importance of physical activity, parental supervision, and continuation of healthcare assistance through telemedicine in young individuals with type 1 diabetes.


Subject(s)
COVID-19/prevention & control , Diabetes Mellitus, Type 1/drug therapy , Glycemic Control/methods , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Pandemics/prevention & control , Quarantine , Adolescent , Blood Glucose , COVID-19/epidemiology , Child , Communicable Disease Control/methods , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/epidemiology , Female , Glycated Hemoglobin A/analysis , Glycated Hemoglobin A/metabolism , Humans , Hypoglycemic Agents/therapeutic use , Infusions, Subcutaneous , Insulin Infusion Systems/adverse effects , Male , Portugal/epidemiology , Retrospective Studies , SARS-CoV-2
4.
Am J Health Syst Pharm ; 79(6): 452-458, 2022 03 07.
Article in English | MEDLINE | ID: covidwho-1545903

ABSTRACT

PURPOSE: Inpatient diabetes management involves frequent assessment of glucose levels for treatment decisions. Here we describe a program for inpatient real-time continuous glucose monitoring (rtCGM) at a community hospital and the accuracy of rtCGM-based glucose estimates. METHODS: Adult inpatients with preexisting diabetes managed with intensive insulin therapy and a diagnosis of coronavirus disease 2019 (COVID-19) were monitored via rtCGM for safety. An rtCGM system transmitted glucose concentration and trending information at 5-minute intervals to nearby smartphones, which relayed the data to a centralized monitoring station. Hypoglycemia alerts were triggered by rtCGM values of ≤85 mg/dL, but rtCGM data were otherwise not used in management decisions; insulin dosing adjustments were based on blood glucose values measured via fingerstick blood sampling. Accuracy was evaluated retrospectively by comparing rtCGM values to contemporaneous point-of-care (POC) blood glucose values. RESULTS: A total of 238 pairs of rtCGM and POC data points from 10 patients showed an overall mean absolute relative difference (MARD) of 10.3%. Clarke error grid analysis showed 99.2% of points in the clinically acceptable range, and surveillance error grid analysis showed 89.1% of points in the lowest risk category. It was determined that for 25% of the rtCGM values, discordances in rtCGM and POC values would likely have resulted in different insulin doses. Insulin dose recommendations based on rtCGM values differed by 1 to 3 units from POC-based recommendations. CONCLUSION: rtCGM for inpatient diabetes monitoring is feasible. Evaluation of individual rtCGM-POC paired values suggested that using rtCGM data for management decisions poses minimal risks to patients. Further studies to establish the safety and cost implications of using rtCGM data for inpatient diabetes management decisions are warranted.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adult , Blood Glucose/analysis , Blood Glucose Self-Monitoring/methods , COVID-19/drug therapy , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemic Agents , Insulin/adverse effects , Retrospective Studies , SARS-CoV-2
5.
Am J Physiol Endocrinol Metab ; 322(1): E44-E53, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1518165

ABSTRACT

In December 2019, a pandemic emerged due to a new coronavirus that imposed various uncertainties and discoveries. It has been reported that diabetes is a risk factor for worst outcomes of COVID-19 and also that SARS-CoV-2 infection was correlated with the occurrence of diabetic ketoacidosis (DKA) in patients. The aim of this work is to discuss this correlation emphasizing the main case reports from 2020 while exploring the management of DKA during the course of COVID-19. Web of Science, PubMed, and Scopus databases were searched using two sets of Medical Subject Heading (MeSH) search terms or Title/Abstract words: Coronavirus Infections (Coronavirus Infections, Middle East Respiratory Syndrome, COVID-19) and Diabetic Ketoacidosis (Diabetic Ketoacidosis, Diabetic Acidosis, Diabetic Ketosis). There is a clear correlation between COVID-19 and DKA. The SARS-Cov-2 infection may precipitate both a hyperglycemic state and ketoacidosis occurrence in patients with diabetes and nondiabetic patients, which may lead to fatal outcomes. DKA in patients with COVID-19 may increase risk and worse outcomes. Hence, the SARS-Cov-2 infection presents a new perspective toward the management of glycemia and acidosis in patients with diabetes and nondiabetic patients, highlighting the need for rapid interventions to minimize the complications from COVID-19 while reducing its spreading.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/complications , Blood Glucose/analysis , Blood Glucose Self-Monitoring , COVID-19/metabolism , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/metabolism , Diabetic Ketoacidosis/drug therapy , Diabetic Ketoacidosis/metabolism , Humans , Hyperglycemia/complications , Hyperglycemia/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Prognosis , Risk Factors , Telemedicine
6.
Br J Community Nurs ; 26(11): 544-552, 2021 Nov 02.
Article in English | MEDLINE | ID: covidwho-1506202

ABSTRACT

Type 1 diabetes is a lifelong condition which affects all age ranges, for reasons unknown, and the UK has one of the highest incidences of this complex condition in the world. Type 1 diabetes is caused by autoimmune damage to the insulin-producing ß-cells found in the pancreatic islet cells, leading to severe insulin deficiency. People with diabetes need to achieve a target glyosylated haemoglobin level to avoid macro- and microvascular complications, but there is the associated risk of hypoglycaemic events. These can vary in severity and consequences but will likely always cause worry for the person living with diabetes. There are many risk factors and reasons to be explored when looking at hypoglycaemia. This case study explores the nursing interventions that can be safely worked through and prioritised, within the community setting, to allow people with diabetes to be safe from severe hypoglycaemia, thus improving their quality of life and safety, as well as reducing costs for the NHS.


Subject(s)
Blood Glucose Self-Monitoring/methods , Diabetes Mellitus, Type 1/nursing , Glycated Hemoglobin A/analysis , Hypoglycemia/prevention & control , Hypoglycemic Agents/administration & dosage , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemia/etiology , Hypoglycemia/nursing , Hypoglycemic Agents/therapeutic use , Quality of Life
7.
J Autoimmun ; 125: 102738, 2021 12.
Article in English | MEDLINE | ID: covidwho-1466582

ABSTRACT

Autoimmune diseases, including autoimmune endocrine diseases (AIED), are thought to develop following environmental exposure in patients with genetic predisposition. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and vaccines against it could represent new environmental triggers for AIED. We report a patient, with history of vitiligo vulgaris and 8 years of type 2 diabetes, who came to our institution because of fever, weight loss, asthenia and thyrotoxicosis occurred 4 weeks later the administration of BNT162B2 (Pfizer-BioNTech) SARS-CoV-2 vaccine. Clinical, biochemical and instrumental work-up demonstrated Graves' disease and autoimmune diabetes mellitus. The occurrence of these disorders could be explained through different mechanism such as autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome), mRNA "self-adjuvant" effect, molecular mimicry between human and viral proteins and immune disruption from external stimuli. However further studies are needed to better understand the underlying pathogenesis of AIED following SARS-CoV-2 vaccine.


Subject(s)
/adverse effects , COVID-19/prevention & control , Diabetes Mellitus, Type 1/etiology , Graves Disease/etiology , Molecular Mimicry/immunology , Adjuvants, Immunologic/adverse effects , Autoantibodies/blood , C-Peptide/blood , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Glycated Hemoglobin A/analysis , Glycemic Control , Humans , Male , Middle Aged , SARS-CoV-2/immunology , Thyrotoxicosis/pathology , Vitiligo/pathology
9.
Diabetes Technol Ther ; 23(S3): S1-S4, 2021 09.
Article in English | MEDLINE | ID: covidwho-1442997
10.
Diabetes Res Clin Pract ; 180: 109066, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1433132

ABSTRACT

AIMS: To assess the effects of lockdown due to COVID-19 pandemic on glucose metrics, measured by glucose monitoring systems, in adult individuals with type 1 diabetes. METHODS: We conducted a systematic literature search for English language articles from MEDLINE, Scopus and Web of Science up to February 28, 2021, using "diabetes", "lockdown", and "glucose" as key search terms. Time in range (TIR) was the main outcome; other metrics were time above range (TAR), time below range (TBR), mean blood glucose (MBG) and its variability (%CV), estimated HbA1c (eA1c) or glucose management indicator (GMI). RESULTS: Seventeen studies for a total of 3,441 individuals with type 1 diabetes were included in the analysis. In the lockdown period, TIR 70-180 mg/dl increased by 3.05% (95% CI 1.67-4.43%; p < 0.0001) while TAR (>180 mg/dL and > 250 mg/dL) declined by 3.39% (-5.14 to -1.63%) and 1.96% (-2.51 to -1.42%), respectively (p < 0.0001 for both). Both TBR < 70 and <54 mg/dL remained unchanged. MBG slightly decreased by 5.40 mg/dL (-7.29 to -3.51 mg/dL; p < 0.0001) along with a reduction in %CV. Pooled eA1c and GMI decreased by 0.18% (-0.24 to -0.11%; p < 0.0001) and a similar reduction was observed when GMI alone was considered (0.15%, -0.23 to -0.07%; p < 0.0001). Sensor use was only slightly but not significantly reduced during lockdown. CONCLUSIONS: This meta-analysis shows that well-controlled people with type 1 diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adult , Blood Glucose , Blood Glucose Self-Monitoring , Communicable Disease Control , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Glycemic Control , Humans , Pandemics , SARS-CoV-2
11.
Diabetes Technol Ther ; 23(9): 632-641, 2021 09.
Article in English | MEDLINE | ID: covidwho-1387687

ABSTRACT

Aims: To investigate the short-term effects of the first wave of COVID-19 on clinical parameters in children with type 1 diabetes (T1D) from 82 worldwide centers participating in the Better Control in Pediatric and Adolescent DiabeteS: Working to CrEate CEnTers of Reference (SWEET) registry. Materials and Methods: Aggregated data per person with T1D ≤21 years of age were compared between May/June 2020 (first wave), August/September 2020 (after wave), and the same periods in 2019. Hierarchic linear and logistic regression models were applied. Models were adjusted for gender, age-, and diabetes duration-groups. To distinguish the added burden of the COVID-19 pandemic, the centers were divided into quartiles of first wave COVID-19-associated mortality in their country. Results: In May/June 2019 and 2020, respectively, there were 16,735 versus 12,157 persons, 52% versus 52% male, median age 13.4 (Q1; Q3: 10.1; 16.2) versus13.5 (10.2; 16.2) years, T1D duration 4.5 (2.1; 7.8) versus 4.5 (2.0; 7.8) years, and hemoglobin A1c (HbA1c) 60.7 (53.0; 73.8) versus 59.6 (50.8; 70.5) mmol/mol [7.8 (7.0; 8.9) versus 7.6 (6.8; 8.6) %]. Across all country quartiles of COVID-19 mortality, HbA1c and rate of severe hypoglycemia remained comparable to the year before the first wave, while diabetic ketoacidosis rates increased significantly in the centers from countries with the highest mortality rate, but returned to baseline after the wave. Continuous glucose monitoring use decreased slightly during the first wave (53% vs. 51%) and increased significantly thereafter (55% vs. 63%, P < 0.001). Conclusions: Although glycemic control was maintained, a significant rise in DKA at follow-up was seen during first wave in the quartile of countries with the highest COVID mortality. Trial Registration: NCT04427189.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Glycemic Control , Adolescent , Blood Glucose , Blood Glucose Self-Monitoring , Child , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Diabetic Ketoacidosis/epidemiology , Female , Glycated Hemoglobin A/analysis , Humans , Male , Pandemics
12.
Diabetes Res Clin Pract ; 179: 109022, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1370489

ABSTRACT

In patients with autoimmune diabetes no significant differences were observed in glucose control, expressed as time in range evaluated by continuous glucose monitoring comparing the 3 days after Sars-Cov2 vaccine with the 14 days preceding the vaccine.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Blood Glucose , Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 1/drug therapy , Glucose , Humans , RNA, Viral , SARS-CoV-2 , Vaccination
13.
Clin Med (Lond) ; 21(4): e323-e326, 2021 07.
Article in English | MEDLINE | ID: covidwho-1357649

ABSTRACT

Insulin is required for all people living with type 1 diabetes, and may be required in nearly half of those with type 2 diabetes. It is a complex drug, manufactured in several forms and utilised in various regimens and devices. There is evidence that non-specialist professionals lack confidence in insulin therapy and, in addition, insulin-related prescribing errors are common in hospital care. In this article, I summarise commonly used insulin regimens, along with indications and safety considerations when prescribing insulin therapy.


Subject(s)
Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Physicians , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use
14.
Int J Clin Pract ; 75(12): e14714, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1348136

ABSTRACT

INTRODUCTION: The COVID-19 vaccination programme is under way worldwide. Anecdotal evidence is increasing that some people with type 1 diabetes mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before/after vaccination. METHODS: We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage (%) BG readings in the designated target range 3.9-10 mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1). RESULTS: There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ± SE 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ± SE 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1%-13.9%/≥14%. There was no significant change in BG variability in the 7days post-COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal-bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age <53 vs ≥53 years (greater reduction in %BG in target for older individuals (-18% vs -9%)). CONCLUSION: In T1DM, we have shown that COVID-19 vaccination can cause temporary perturbation of BG, with this effect more pronounced in patients talking oral hypoglycaemic medication plus insulin, and in older individuals. This may also have consequences for patients with T2DM who are currently not supported by flash glucose monitoring.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adult , Aged , Blood Glucose , Blood Glucose Self-Monitoring , COVID-19 Vaccines , Diabetes Mellitus, Type 1/drug therapy , Glucose , Humans , Hypoglycemic Agents , Insulin , Middle Aged , SARS-CoV-2 , Vaccination
15.
Diabetes Res Clin Pract ; 178: 108988, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1330747

ABSTRACT

AIMS: Our observational study aimed to evaluate the impact of the lockdown period due to 2019 Coronavirus disease pandemic on glycaemic control in a cohort of paediatric patients with type 1 diabetes (T1D). METHODS: Eighty-five patients with T1D aged 5-18 years using continuous glucose monitoring (CGM) systems were enrolled. Demographic and clinical data, including glucose metrics generated by CGM-specific web-based cloud platforms, were collected in three different periods (pre-lockdown phase, lockdown phase, and post-lockdown phase) of 90 days each and were statistically analysed. RESULTS: During the lockdown period, a clear improvement in almost all CGM metrics (time in range, time above range, coefficient of variation, and glucose management indicator) was observed in our study population, regardless of age and insulin type treatment. In the months following lockdown, maintaining satisfactory diabetes outcomes was confirmed only in younger patients (aged 5-9 years) and in those individuals on hybrid closed loop therapy. CONCLUSIONS: The increasing use of innovative technological devices together with data sharing systems and interaction with multidisciplinary diabetes team through telemedicine allowed paediatric patients with T1D to improve glucose metrics during the lockdown period. However, our findings showed that the achievement of better glycaemic control was transient for most patients.


Subject(s)
COVID-19 , Communicable Disease Control , Diabetes Mellitus, Type 1 , Glycemic Control , Adolescent , Benchmarking , Blood Glucose , Blood Glucose Self-Monitoring , Child , Child, Preschool , Diabetes Mellitus, Type 1/drug therapy , Female , Humans , Hypoglycemic Agents/therapeutic use , Male
17.
Prim Care Diabetes ; 15(5): 793-798, 2021 10.
Article in English | MEDLINE | ID: covidwho-1313366

ABSTRACT

AIM: To minimize the spread of COVID-19, the Kingdom of Saudi Arabia (KSA) enforced a nationwide lockdown. We aimed to explore whether the manner in which Saudi patients with type 1 diabetes (T1D) manage their disease has changed during this unparalleled lockdown. METHODS: An online survey exploring the effect of lockdown on T1D outcomes was distributed among T1D patients residing in KSA during lockdown. RESULTS: A total of 1010 patients responded to the survey. Around 40% reported communicating with their physicians during lockdown. Age, level of education, residence, previous visits to diabetes education clinics, last HbA1c value, and average monthly income were all significantly associated with communication with the treating physician (p = 0.008, p < 0.001, p < 0.001, p = 0.002, p < 0.001, and p < 0.001, respectively). Age, level of education, and average monthly income were significantly associated with experiencing severe hypoglycemia (p = 0.036, p = 0.03, and p < 0.001, respectively), while average monthly income and level of education were significantly associated with experiencing diabetic ketoacidosis (DKA) (p < 0.001 and p = 0.0039, respectively); during lockdown. Patients who communicated with their physicians reported lower rates of severe hypoglycemia compared to those who did not (25.2% vs 30.7%, respectively). CONCLUSION: Age and level of education were significantly associated with communication with the treating physician, and experiencing severe hypoglycemia and DKA; in patients with T1D during the lockdown period in Saudi Arabia. Keeping two-way virtual communication channels between physicians and their T1D patients should be encouraged.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Communicable Disease Control , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Humans , SARS-CoV-2 , Saudi Arabia/epidemiology
18.
BMJ Open ; 11(7): e050713, 2021 07 14.
Article in English | MEDLINE | ID: covidwho-1311169

ABSTRACT

INTRODUCTION: Optimising glycaemic control in type 1 diabetes (T1D) remains challenging. Flash glucose monitoring with FreeStyle Libre 2 (FSL2) is a novel alternative to the current standard of care self-monitoring of blood glucose (SMBG). No randomised controlled trials to date have explored the potential benefits of FSL2 in T1D. We aim to assess the impact of FSL2 in people with suboptimal glycaemic control T1D in comparison with SMBG. METHODS: This open-label, multicentre, randomised (via stochastic minimisation), parallel design study conducted at eight UK secondary and primary care centres will aim to recruit 180 people age ≥16 years with T1D for >1 year and glycated haemoglobin (HbA1c) 7.5%-11%. Eligible participants will be randomised to 24 weeks of FSL2 (intervention) or SMBG (control) periods, after 2-week of blinded sensor wear. Participants will be assessed virtually or in-person owing to the COVID-19 pandemic. HbA1c will be measured at baseline, 12 and 24 weeks (primary outcome). Participants will be contacted at 4 and 12 weeks for glucose optimisation. Control participants will wear a blinded sensor during the last 2 weeks. Psychosocial outcomes will be measured at baseline and 24 weeks. Secondary outcomes include sensor-based metrics, insulin doses, adverse events and self-report psychosocial measures. Utility, acceptability, expectations and experience of using FSL2 will be explored. Data on health service resource utilisation will be collected. ANALYSIS: Efficacy analyses will follow intention-to-treat principle. Outcomes will be analysed using analysis of covariance, adjusted for the baseline value of the corresponding outcome, minimisation factors and other known prognostic factors. Both within-trial and life-time economic evaluations, informed by modelling from the perspective of the National Health Service setting, will be performed. ETHICS: The study was approved by Greater Manchester West Research Ethics Committee (reference 19/NW/0081). Informed consent will be sought from all participants. TRIAL REGISTRATION NUMBER: NCT03815006. PROTOCOL VERSION: 4.0 dated 29 June 2020.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adolescent , Blood Glucose , Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemic Agents , Multicenter Studies as Topic , Pandemics , Randomized Controlled Trials as Topic , SARS-CoV-2 , State Medicine , United Kingdom
19.
Prim Care Diabetes ; 15(5): 884-886, 2021 10.
Article in English | MEDLINE | ID: covidwho-1294129

ABSTRACT

There has been little data published related to glucose control in adolescents and young adults with type 1 diabetes (T1D) during lockdown, but rarely focusing on telemedicine's role. During this unpreceded period, glucose control and self-monitoring improved in our young patients, with better results associated with telemedicine.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Telemedicine , Adolescent , Blood Glucose , Blood Glucose Self-Monitoring , Communicable Disease Control , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Humans , Pandemics , SARS-CoV-2 , Young Adult
20.
Diabet Med ; 38(11): e14608, 2021 11.
Article in English | MEDLINE | ID: covidwho-1273085

ABSTRACT

AIMS: Aim of this study is to report severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, responsible for coronavirus disease 2019 (COVID-19), as a possible cause for type 1 diabetes by providing an illustrative clinical case of a man aged 45 years presenting with antibody-negative diabetic ketoacidosis post-recovery from COVID-19 pneumonia and to explore the potential for SARS-CoV-2 to adhere to human islet cells. METHODS: Explanted human islet cells from three independent solid organ donors were incubated with the SARS-CoV-2 spike protein receptor biding domain (RBD) fused to a green fluorescent protein (GFP) or a control-GFP, with differential adherence established by flow cytometry. RESULTS: Flow cytometry revealed dose-dependent specific binding of RBD-GFP to islet cells when compared to control-GFP. CONCLUSIONS: Although a causal basis remains to be established, our case and in vitro data highlight a potential mechanism by which SARS-CoV-2 infection may result in antibody-negative type 1 diabetes.


Subject(s)
COVID-19/therapy , Diabetes Mellitus, Type 1/diagnosis , Diabetic Ketoacidosis/diagnosis , Islets of Langerhans/metabolism , SARS-CoV-2/metabolism , Spike Glycoprotein, Coronavirus/metabolism , COVID-19/complications , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/etiology , Diabetic Ketoacidosis/etiology , Diabetic Ketoacidosis/therapy , Humans , In Vitro Techniques , Male , Middle Aged
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