Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England

Abstract

Aims People with type 1 diabetes (T1D) face the daily task of implementing self-management strategies to achieve their glycaemic goals. The UK COVID-19 lockdown has had an impact on day-to-day behaviour, which may affect diabetes self-management and outcomes. We assessed whether sensor-based outcomes pre- and during lockdown periods were different in a cohort of glucose sensor users with T1D. Methods Data were collected from Freestyle Libre (FSL) or Dexcom G6 sensor users who remotely shared their data with the diabetes clinic web platform. Sensor metrics according to international consensus were analysed and compared between pre-lockdown period and 2 and 3 weeks into lockdown (periods 1 and 2). Results Two hundred and sixty-nine T1D patients (baseline HbA1c 57 ± 14 mmol/mol) were identified as FSL (n = 190) or Dexcom G6 (n = 79) users. In patients with sensor use > 70% (N = 223), compared to pre-lockdown period percentage TIR 3.9–10 mM (TIR) significantly increased during period 1 (59.6 ± 18.2 vs. 57.5 ± 17.2%, p = 0.002) and period 2 (59.3 ± 18.3 vs. 57.5 ± 17.2%, p = 0.035). The proportion of patients achieving TIR ≥ 70% increased from 23.3% pre-lockdown to 27.8% in period 1 and 30.5% in period 2. A higher proportion also achieved the recommended time below and above range, and coefficient of variation in periods 1 and 2. Dexcom G6 users had significantly lower % time below range (< 3.9 mM) compared to FSL users during both lockdown periods (period 1: Dexcom G6 vs. FSL: 1.8% vs. 4%; period 2: 1.4% vs. 4%, p < 0.005 for both periods). Conclusion Sensor-based glycaemic outcomes in people with T1D in the current cohort improved during COVID-19 lockdown, which may be associated with positive changes in self-management strategies. Further work is required to evaluate long-term sustainability and support.

Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review

“…Overall, we analyzed n = 2881 T1D patients. Of n = 25 T1D studies, n = 18 (72%) showed clear, significant improvements in glycemic control [ 14 – 31 ], n = 4 (16%) showed stability (no changes) [ 32 – 35 ] and n = 3 (12%) deteriorations [ 36 – 38 ]. In n = 10 studies, the patients received CGM treatment, in n = 5 studies FGM, in n = 2 studies HCL, in n = 1 study SAP, in n = 5 studies mixed types of technology such as MDI, CSII, CGM, FGM, insulin pump, and in n = 2 papers no digital treatments were described.…”

The Impact of COVID-19-Related Lockdown on Diet and Serum Markers in Healthy Adults

“…A study among patients with well-controlled type 2 diabetes mellitus showed worse glucose control during lockdown, which was worse among patients with higher fasting triglyceride levels pre-lockdown [ 30 ]. On the contrary, some studies found better glycaemic control in patients with type 1 diabetes mellitus during lockdown, which could be due to having more time for self-management during lockdown, at least in the short term [ 29 , 31 , 32 , 33 ] or due to reduced work-related stress [ 34 ].…”

Study on the effects of changes in lifestyle of patients with diabetes on glycaemic control before and after the declaration of the state of emergency in Japan

“…For T1DM, there are many reports of improved glycaemic control. Improvement has been reported in many countries, such as India [ 9 ], the UK [ 10 , 11 ], and Spain [ 12 – 14 ]. In contrast, a report of 50 patients in Rome, Italy, indicated that glycaemic control was markedly worsened during the lockdown [ 15 ], and a study of 52 patients in Rohtak, an industrial city in Northern India, reported an increase from 8.8 ± 1.3% before the lockdown to 10.0 ± 1.5% after the lockdown [ 16 ].…”

“…Reports available to date show results that vary among regions and subjects [5][6][7][8][9][10][11][12][13][14][15][16]. There is, however, still no report on the actual conditions of changes in lifestyle and treatment status of patients with diabetes before and after the declaration.…”