Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic

Abstract

IntroductionLockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes.Research design and methodsWe performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown.ResultsIn total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: −0.39% (−4.3 mmol/mol) (p<0.0001 and type 2 diabetes: −0.62% (−6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001).ConclusionsAn increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.

Impact of COVID-19 pandemic on glycemic control among outpatients with type 2 diabetes in Japan: A hospital-based survey from a country without lockdown

“…Similar findings were reported in the Netherlands [7], France [8], Italy [9,10], Greece [11] and by a separate group in Spain [12]. However, these studies included only patients with type 1 diabetes that were using CGM; these patients may have been better placed to manage their disease than were their counterparts, as they could easily monitor their blood glucose levels.…”

“…Herein, we analyzed data collected until August 2020; therefore, the lack of change in BMI may be due to the short observation period. Previous studies on the impact of the COVID-19 pandemic on body weight in patients with diabetes mellitus were inconsistent, reporting an increase [7], no change [18,[21][22][23], and a decrease [19]. These previous studies also had short observation periods.…”

“…(1,164 patients) was the same as that observed between March and April 2019 (1,135 patients); meanwhile, the number of patients who requested telemedicine consultations was 30 (1.7%) in the present study sample. These findings suggest that the rate of measurements of HbA1c values at our clinic was not reduced during the pandemic, unlike in countries that imposed lockdowns [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

COVID-19 and Diabetes: Understanding the Interrelationship and Risks for a Severe Course

“…In both T1D and T2D, patients in the highest pre-lockdown tertile of HbA1c showed the biggest improvement in HbA1c (T1D -4.3 mmol/mol (-0.39%); T2D -6.8 mmol/mol (-0.62%)). Improved continuous glucose monitoring data in patients with T1D reflected this observation (142). Smaller studies during the lockdown in Italy as well as Spain additionally supported this finding, with improved glucose time in range (3.9 -10.0 mmol/l; 70 -180 mg/dL), reduced time above range (> 10.0 mmol/l (180 mg/dL)) and reduced time below range (< 3.9 mmol/l (70 mg/dL)) in patients with diabetes who stayed at home during the lockdown (143)(144)(145).…”

Exploring support needs of people living with diabetes during the coronavirus COVID-19 pandemic: insights from a UK survey

“…12 Closure of sporting facilities and home confinement have contributed to a reduced exercise, adoption of unhealthy dietary habits and weight gain in people with diabetes. 13 This reflects respondents' decreased confidence in self-management in these domains.…”