How our families fared with type 1 diabetes home management during the COVID-19 pandemic 2020 lockdown

ABSTRACT

Introduction: At the onset of the COVID-19 pandemic, there was limited data and conflicting evidence regarding the effect of the pandemic on type 1diabetes (T1DM). It was expected that there may be adverse effects on glycemic control and mortality, more so in developing countries like India, with the additional burden of the lockdown on economy and health care. Subsequently, adult and pediatric data from developed countries regarding glycemic control in patients with T1DM were reassuring. Indian data, as well as data from other developing countries from pediatric T1DM addressing such issues are sparse and have conflicting conclusions. Furthermore, possible factors influencing glycemic control were not evaluated by most reports from our country. Objective(s) We evaluated the effect of the 2020 lockdown on glycemic control and lifestyle of children withtype1diabetes (T1DM). Method(s) Children and young adults with T1DM (n = 104, mean +/- SD age 13.4 +/- 4.5 years), were questioned telephonically, regarding access to health care, insulin, food and lifestyle changes during lockdown. Pre and post lockdown HbA1c, body weight, and modifying factors were analyzed. Result(s) A change in brand of insulin was necessary in 54% and physiologically wrong insulin was being used in 4.8% patients. HbA1c improved significantly post lockdown versus the 1 year pre-COVID average (7.59 +/- 1.77 vs. 8.61 +/- 1.80, p < 0.05). Parents attributed it to better supervision by (both) parents due to their presence at home, and less opportunity to consume energy dense food. Median (IQR) home blood glucose testing frequency was significantly low during lockdown [14(15) vs. 21.5(3.7) pre-lockdown, p < 0.001]. Decreased exercise occurred in 40% and excess weight gain in 51.5%. Conclusion(s) Despite problems of access to health care and adverse lifestyle conditions, improved parental supervision and meal quality and timing had favorable effect on diabetes management, which is reflected by improvement of HbA1c in a small cohort of our children.