Health-related quality of life and metabolic control in children and young patients with type 1 diabetes and in their parents before and after the COVID-19 lockdown

ABSTRACT

Introduction: Italy was the first EU country to be affected by COVID-19 outbreak. The sudden change in everyday life was challenging for children and young people (CYP) who rely heavily on peer connections for emotional and social support. Concerns for consequences in CYP with type 1 diabetes (T1D) rose. Objective(s) To compare the diabetes-specific health-related quality of life (D-HRQOL) of CYP with T1D and their parents and the glycemic control before and after COVID-19-related lockdown. Method(s) The Pediatric Quality of Life InventoryTM 3.0 Diabetes Module (PedsQLTM 3.0 DM) was used to evaluate the D-HRQOL. Patients who filled the D-HRQOL before lockdown (December 2019-February 2020;T0) were recruited in the study and filled the same survey immediately after the lockdown was stopped (June 2020;T1) during a routine outpatient or telemedicine visit. Data on diabetic ketoacidosis (DKA), severe hypoglycemic events, insulin therapy [dose and delivery method (MDI/CSII)], glucose monitoring method (SBGM/isCGM/rtCGM), glycosylate hemoglobin (HbA1c), physical activity (h/week), and SARS-CoV-2 infection were also collected. Continuous and categorical data are reported as median and percentage, respectively. Result(s) Sixty-two CYP (males 48.4%;age 12.6 [5.25-17.8] years;T1D duration 4.23 [0.45- 16.4] years;MDI 71%;rtCGM 52%, SBGM 29%, and isCGM 19%;telemedicine visit 56.5%) with T1D and their parents (60 mothers, 10 fathers) were enrolled. Patients' and fathers' scales scores did not significantly change from T0 to T1. Mothers' 'Diabetes symptoms' scale score increased (67.0 vs. 70.4;p=0.007). According to visit type (outpatient vs. telemedicine), glucose monitoring (SBGM vs. isCGM vs. rtCGM), and insulin therapy (MDI vs. CSII), D-HRQOL data were longitudinally comparable and no differences was found between groups. During lockdown no DKA, severe hypoglycemic events, and SARS-CoV-2 were recorded in patients. Despite the significant decrease of exercise from T0 to T1 (3.25 vs. 0.50 h/week;p<0.0001), glycemic control (HbA1c 58.5 vs. 57.9 mmol/mol) and total daily insulin dose (0.86 vs. 0.82 IU/kg/day) were unchanged. At T1, the lower the HbA1c, the better patients' 'Diabetes symptoms' (R=-0.41, p<0.001), 'Worry' (R=-0.27, p=0.032) scales, and total scores (R=-0.33, p=0.009). Similar results were found in parents. Conclusion(s) During COVID-19 pandemic-related lockdown the D-HRQOL did not change in CYP with T1D and their parents. During visits we stressed the importance to keep a balanced nutritional program, according to new time spent on exercise, making diabetes managements easier and allowing the maintenance of good glycemic control without acute complications.