Glycemic Control in Type 1 Diabetes Mellitus During COVID-19 Quarantine and the Role of In-Home Physical Activity

Abstract

Background: To limit the spread of coronavirus disease 2019 , governments have ordered a series of restrictions that may affect glycemic control in individuals with type 1 diabetes mellitus (T1DM), since physical activity (PA) was not allowed outside home. Methods: We retrospectively evaluated glycemic control of individuals with T1DM using hybrid closed loop (HCL) system in the period before the SARS-CoV-2 outbreak in Italy (February 10-23, 2020-Time 1), when movements were only reduced (February 24-March 8, 2020-Time 2) and during complete lockdown (March 9-22, 2020-Time 3). Information about regular PA (at least 3 h per week) prior and during the quarantine was collected. Results: The study included 13 individuals with a median age of 14.2 years and a good glycemic control at baseline (glucose management indicator of 7%, time in range [TIR] of 68%, time below range [TBR] of 2%). All individuals continued to show good glycemic control throughout the study period. There was an increase in TIR during the study period (+3%) and TIR was significantly higher during Time 3 (72%) than during Time 2 (66%). TBR was significantly lower during Time 3 (1%) both compared with Time 1 and Time 2 (2%). A meaningful variance in TIR at Time 3 between individuals who performed or not PA during quarantine and a significant increase in TIR between Time 2 and Time 3 in individuals both doing PA at baseline and during quarantine was found. At logistic regression, only the presence of PA during quarantine significantly predicted a TIR >70%. Conclusions: Glycemic control of T1DM in adolescents using HCL system did not worsen during the restrictions due to COVID-19 pandemics and further improved in those who continued PA during the quarantine. Maintaining regular PA in a safe home environment is an essential strategy for young individuals with T1DM during the COVID-19 crisis.

COVID-19 pandemic: a double trouble for Indian adolescents and young adults living with type 1 diabetes

“…We found that participants with a higher PSS-10 score reported worsened glycemic control on SMBG in the preceding 4 weeks. This is in contrast to other studies performed in developed countries that demonstrated no deterioration [24,25], or even an improvement [26] in glycemic control during the lockdown period, attributed to improved self-care. This dissimilarity could possibly be attributed to the differences in the study population.…”

Determinants of the Lifestyle Changes during COVID-19 Pandemic in the Residents of Northern Italy

“…In our cohort, the most receptive people seemed to be those with a higher educational level who were less likely to reduce physical activity and younger people because being older than 30 years made the increase in physical activity during home confinement less likely. However a recent study showed that the metabolic control of Type 1 Diabetes in adolescents did not worsen during the restrictions due to COVID-19 pandemics and further improved in those who continued physical activity during the quarantine [ 15 ], demonstrating the power of regular physical activity as an essential strategy for healthy living during the COVID-19 crisis, especially for individuals with chronic diseases. In the present study, only 23% of subjects reported to be affected by a chronic disease and the questionnaire did not investigate the type of the chronic disease.…”

Management of glucose profile throughout strict COVID-19 lockdown by patients with type 1 diabetes prone to hypoglycaemia using sensor-augmented pump

“…Bonora et al [ 13 ] described 33 individuals with T1D using CGM who improved TIR from 54.4 to 65.2% during the lockdown in those who stayed at home, with no changes in those who kept working. Tornese et al [ 14 ] reported 13 adolescents treated with an HCL system and good glycemic control at baseline (TIR 68%), in which glycemic control improved (+ 3%) especially in those who continued physical activity during the lockdown. Recently, Beato [ 15 ] has described the effects of the lockdown in a Spanish population, showing no deleterious effect of the lockdown in a cohort of patients with T1D treated with multiple insulin injections and CGM.…”