Effect of Covid-19 quarantine on diabetes Care in Children

Abstract

Background With the onset of the COVID-19 pandemic and state-mandated school closures in the spring of 2020, the management of type 1 diabetes in children underwent significant changes. The aim of our study was to assess the effect of stay-at-home orders on glycemic control in children. Methods We conducted a retrospective review of 238 children with type 1 and type 2 diabetes who were seen in the Pediatric Endocrinology Clinic at the University of South Alabama. Average Hemoglobin A1c (A1c) levels in the year prior to stay-at home orders (May 2019–April 2020) were compared with A1c values during the quarantine period (May 2020–July 2020) using a paired t-test. We also analyzed the change of A1c level with respect to sex, race, type of diabetes, type of insurance, and mode of insulin administration, using a 2-sample t-test. Results The average A1c significantly increased from 9.2% during the previous year to 9.5% during the quarantine period (p = 0.0097). The increase of A1c was significantly higher in public insurance patients (0.49% increase) compared to private insurance patients (0.03% increase), (p = 0.0137). We also observed a significant association between the direction of change and type of insurance. Forty-eight percent of public insurance patients had an A1c increase of > 0.5% while 54% of private insurance patients had no change or decrease in A1c (p = 0.0079). Conclusions The COVID-19 pandemic resulted in worsening glycemic control in children with type 1 diabetes, with those on public insurance affected in greater proportion than those with private insurance.

Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses

“…Individuals will continue to experience fast metabolic decompensation, resulting in DKA, if the diagnosis of DM1 is delayed [ 136 ], as we saw during the COVID-19 pandemic. DKA is linked to increased morbidity and death, and our metanalysis suggests the necessity for focused public awareness efforts aimed at preventing DKA upon DM1 diagnosis by recognizing and treating symptoms early.…”

Children with type 1 diabetes in COVID-19 pandemic: Difficulties and solutions

“…The COVID-19 pandemic has led to an economic crisis, and those whose financial stability was already difficult were first to suffer[ 37 ]. Researchers found that minority children had a higher glycosylated hemoglobin (HbA1c) level both in the pre-pandemic and the lockdown period than white race[ 38 - 40 ]. Similarly, patients with medical aid had a notably higher HbA1c and increase in HbA1c during the lockdown than those with private insurance[ 38 ].…”

“…Researchers found that minority children had a higher glycosylated hemoglobin (HbA1c) level both in the pre-pandemic and the lockdown period than white race[ 38 - 40 ]. Similarly, patients with medical aid had a notably higher HbA1c and increase in HbA1c during the lockdown than those with private insurance[ 38 ]. Other publications have also indicated that youth whose families are in a disadvantaged financial condition have poorer glucose control[ 38 - 40 ].…”

“…Similarly, patients with medical aid had a notably higher HbA1c and increase in HbA1c during the lockdown than those with private insurance[ 38 ]. Other publications have also indicated that youth whose families are in a disadvantaged financial condition have poorer glucose control[ 38 - 40 ]. The reason can be ascribed to the fact that many of those are supported by various programs for regular supply of insulin and glucose meterstrips[ 41 ].…”

“…In some families of children and adolescents with T1D, the school nurse provided most of the diabetes care. However, because of the sudden closure of school, parents who needed extra help may have less access to adequate training[ 38 ]. The unavailability of medical appointments, the lack of information about the relationship between COVID-19 and T1D, the difficulty in obtaining specialized support, and the inability to provide quality food and supplies for diabetes during the pandemic may generate negative feelings and insecurity in these caregivers[ 57 , 58 ].…”