CGM Improved Among Youth With T1D During COVID-19 Lockdown

Results of a study conducted in California suggest some adolescents with type 1 diabetes (T1D) improved their glycemic control during the COVID-19 lockdown.

Throughout the COVID-19 pandemic, American youth with type 1 diabetes (T1D) exhibited improvement in continuous glucose monitoring (CGM) metrics, according to study results published in Diabetes Technology & Therapeutics.

To assess what impact the COVID-19 shelter-in-place (SIP) mandate instituted in California had on youths (aged 3-21), researchers conducted a retrospective cohort study at an academic pediatric diabetes center in the San Francisco Bay Area.

“California’s SIP mandate was one of the earliest and strictest mandates in the United States,” the authors wrote. “The mandate closed in-person schooling, required many companies to shift to remote work, restricted nonessential travel and services, and emphasized masking and social distancing.”

The drastic shifts in children’s school and home lives offer a unique opportunity to understand how sudden changes in daily living affect those with diabetes, the researchers explained. Previous studies conducted in Europe yielded mixed results on the pandemic’s effects on average glucose, glycated hemoglobin, glucose management indicator (GMI), and other metrics.

“It is important for clinicians to understand the impact of a stay-at-home order on diabetes management in youth living with T1D, as lessons learned during this time may be applicable to future interruptions in daily life,” they said.

All study participants (n = 85) had used CGM for at least 1 month, had a scheduled clinic encounter with a diabetes provider in June of 2020, and had CGM data for at least 60% of the time over 2-week intervals within 4 defined study periods. These included "distant pre-SIP" or 2 to 4 months prior to the SIP mandate, "immediate pre-SIP" or 1 month immediately prior to the SIP mandate, "immediate post-SIP" or 1 month immediately following the SIP mandate, and "distant post-SIP" or 2 to 4 months following the SIP mandate. The SIP was enacted on March 19, 2020.

Glycemic data were manually collected for all time periods while electronic medical records and web-based data visualization systems (Tidepool or Clarity) were used to collect additional information. Standard deviation (SD) and coefficient of variation were measured to account for changes in glucose variability.

Analyses revealed:

  • Participants had reduced mean (SD) glucose (-10.3 [4.4] mg/dL; P = .009), SD (-5.0 [1.3] mg/dL; P = .003), GMI (-0.2% [0.03%], P = .004), time above range (TAR) > 250 mg/dL (-3.5% [1.7%]; P= .01), and increased time in range (TIR) (4.7% [1.7%]; P = .0025) between the distant pre-SIP and distant post-SIP periods
  • Relationships were maintained using a mixed effects model, when controlling for other demographic variables
  • Multivariate linear regression showed statistically significant associations of private insurance status with an increase in TIR (6.5% [13.1%]), reduced TAR 180-250 mg/dL (-3% [9.4%]), and reduced SD (-6.6 [10.7] mg/dL), whereas public insurance was associated with decreased TIR (-0.9% [11.9%]), increased TAR 180-250 mg/dL (6.9%[14.5%]), and increased SD (2 [16.1] mg/dL) between the distant pre-SIP and post-SIP periods after adjusting for age and gender
  • In the distant post-SIP period, compared with the distant pre-SIP time period, children and adolescents had reduced glycemic variability (SD), whereas young adults had increased glycemic variability

“The results suggest that many families of youth with T1D who use CGM can effectively manage diabetes, despite the limitations presented by the pandemic,” the authors wrote.

Because poor diabetes control was considered a risk factor for more severe COVID-19 outcomes, it is possible families could have been more motivated to better manage glycemic control in the weeks prior to the public health order, they hypothesized.

As patients with private insurance had improved glycemic metrics compared with those with public insurance, “our findings highlight the need to devote efforts to families who may be suffering from multiple challenges during the pandemic, such as those with public insurance, to ensure that they have the resources and support to achieve optimal diabetes management.”

Findings may be limited in generalizability because participants were selected from those who scheduled clinic visits and may have been more engaged in their diabetes care. Data regarding type of insulin delivery system used also were not collected. The study cohort may have already been practicing close to optimal diabetes self-management at baseline, as baseline GMI was measured at 7.6%.

“Studies of more diverse populations, and quantitative and qualitative analyses of race and ethnicity, hospitalizations, socioeconomic factors, lifestyle changes, psychosocial stressors, along with detailed knowledge about the type of insulin pump therapy used, including automated insulin delivery systems, are needed to more completely understand the impact of the pandemic on all youth with T1D,” the authors concluded.

Reference

Abdulhussein F, Chesser H, Boscardin WJ, Wong JC, Gitelman S. Youth with type 1 diabetes had improvement in continuous glucose monitoring metrics during the COVID-19 pandemic. Diabetes Technol Ther. Published online May 27, 2021. doi:10.1089/dia.2021.0131