Glycaemic control in T1D children and adolescents during Portuguese COVID-19 first lockdown: A family's survey report

ABSTRACT

Introduction: From March to May 2020, Portugal was under the first COVID-19 lockdown, which has brought considerable changes to people's lifestyles. Objectives: To evaluate lockdown impact on glycaemic control in children and adolescents with T1D, and identify its potentially related factors. Methods: An observational study based on an anonymous questionnaire sent by email to the families with children and adolescents with T1D living in Portugal. Collected variables demographics, age at onset, insulin treatment, glycaemic control, lifestyle, mental health, SARS-CoV-2 infection, contact with the diabetes team. Data before, during, and after the lockdown was compared. Results: We enrolled 337 subjects, 50% males, with a median age of 13(2-19)y, and a median T1D duration of 5(0-17)y. 87% were on CSII, and 84% had CGM (42% with real-time connection to the caregivers). Before lockdown, median daily exercise was 1(0-4)h, median HbA1c was 7.4(5.2-14.8)%, and median TIR was 60(20-93)%. From March to May 2020, physical activity decreased [Δ -0.5(-3 to 2) h/day;p=0.01], 50.9% of subjects put on weight, and 75.3% needed a rise in total daily insulin. There were 16 cases of metabolic decompensation, mainly for pump failure or insulin omission. When compared to the previous period, there were no differences in median HbA1c [Δ 0 (-5.5 to 3.4)%] or median TIR [Δ -2(-24 to 25)%]. From the 32 SARSCoV- 2 positive cases, 11 had difficulties controlling hyperglycaemia, but only 2 needed hospitalization. In 2020, the median number of appointments per subject was 4(0-10), 30% of which by telemedicine. Only 22.4% of families perceived lockdown as a period of glycaemic deterioration. Conclusions: Glycaemic control did not worsen in our children and adolescents with T1D across the COVID-19 pandemic. Despite being confined at home with scarce exercise and weight increase, the fear of possible higher infection risk, along with family T1D knowledge and supervision, home meals, and telemedicine might have been relevant factors to this shaky balance.