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Cengiz N, Topan A, Akyol Güner T. Evaluation of the relationship between self-care agency and quality of life in adolescents with type 1 diabetes mellitus during COVID-19 pandemic. J Pediatr Nurs 2024; 78:e236-e243. [PMID: 39013702 DOI: 10.1016/j.pedn.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE This study aims to explore the relationship between self-care agency and quality of life among adolescents with Type 1 Diabetes Mellitus (T1DM) during the pandemic. DESIGN AND METHODS The study was conducted with 186 adolescents aged 13-16 who have T1DM and attended a pediatric endocrinology clinic at a Training and Research Hospital in the capital city of Turkey between January 1, 2022, and December 31, 2022. Data from 118 adolescents who met the inclusion criteria and fully completed the survey were used in the analysis. Data were collected using the 'Participant Information Form', 'Self-Care Agency Scale', and 'Kiddo-KINDL Quality of Life Scale'. RESULTS The study found that adolescents with higher self-care agency reported significantly better quality of life. Additionally, significant correlations were observed between self-care agency and adherence to pandemic measures, dietary adjustments, hygiene practices, diabetes management challenges, family communication, sleep duration, dietary patterns, and exercise difficulties (p < 0.05). CONCLUSION During the COVID-19 pandemic, it was evident that the self-care agency and quality of life of adolescents with T1DM were impacted, with those possessing higher self-care agency experiencing better and more meaningful quality of life. APPLICATION TO PRACTICE T1DM affects all aspects of life, and quality of life is considered a critical outcome of diabetes care. It is essential for adolescents to adhere to practices such as regular nutrition, physical activity, blood sugar monitoring, and appropriate insulin intake to achieve optimal glycemic levels and the best possible quality of life. Adolescents should be trained on these issues by pediatric nurses.
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Affiliation(s)
- Nursel Cengiz
- Dr Sami Ulus Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aysel Topan
- Zonguldak Bülent Ecevit University, Faculty of Health Sciences, Dept. of Nursing, Kozlu-Zonguldak, Turkey
| | - Türkan Akyol Güner
- Zonguldak Bülent Ecevit University, Faculty of Health Sciences, Kozlu-Zonguldak, Turkey.
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Morat B, Lucidarme N, Gibert A, Harbulot C, Lachaume N, Gréteau S, Basmaci R. Impact of lockdown on children with type-1 diabetes: returning to the community was associated with a decrease in HbA1c. Front Pediatr 2023; 11:1245861. [PMID: 38188912 PMCID: PMC10769491 DOI: 10.3389/fped.2023.1245861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background In March 2020, a 2-month lockdown of the entire population has been declared in France to limit the spread of COVID-19. Sudden changes in daily life can impact the glycemic control of patients with type 1 diabetes (T1D), especially children and adolescents. We aimed to assess the impact of the lockdown on glycemic control in children and adolescents with T1D. Methods Children with T1D were prospectively recruited in two pediatric centers from May 11 to August 1, 2020. At inclusion, patients and/or parents were asked to fill in a form assessing the patient's lifestyle during the lockdown and a medical case report form was filled in by clinician. The mean of the three last glycated hemoglobin (HbA1c) values obtained before lockdown (HbA1c_mean; before March 17, 2020) was compared to the first HbA1c value measured after the lockdown (HbA1c_after; from May 11 to August 1, 2020). Univariable and multivariable analyses were performed, as appropriate, to identify factors associated with glycemic changes during lockdown. Results One-hundred-and-eighteen children and adolescents (median age was 14.1 years, 50% males) with T1D (median time from diagnosis was 4.1 years) were enrolled in the study. No significant difference was observed between medians of HbA1c_mean and HbA1c_after values (8.37% [7.88; 9.32%] vs. 8.50% [7.70; 9.50%], respectively; p = 0.391). Returning to the community was a protective factor [OR 0.31 (0.09-0.94); p = 0.045]. Patients having increased HbA1c were more frequently in contact with a suspected case of COVID-19 [OR 9.07 (2.15-53.66); p = 0.006], whereas patients having decreased HbA1c had the feeling of increase number of hypoglycemia [OR 0.19 (0.05-0.57); p = 0.006]. Conclusion In our patients, HbA1c before and after the lockdown was stable. In subgroup analysis, returning to the community was a protective factor. In addition, feeling of hypoglycemia was more frequent in the patients with decreased HbA1c.
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Affiliation(s)
- Benjamin Morat
- Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France
| | - Nadine Lucidarme
- Service de Pédiatrie Générale, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - Auriane Gibert
- Service de Pédiatrie Générale, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - Carole Harbulot
- Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France
| | - Noémie Lachaume
- Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France
| | - Stéphanie Gréteau
- Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France
| | - Romain Basmaci
- Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France
- Université Paris Cité, Inserm, IAME, Paris, France
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Nimali Seneviratne S, Kumarihamy Karunathilake CN, Pallegama CM, Malintha Lahiru TG, Jayarajah U. Endocrine manifestations of COVID-19 in children: A scoping review. Best Pract Res Clin Endocrinol Metab 2023; 37:101792. [PMID: 37453832 PMCID: PMC10303324 DOI: 10.1016/j.beem.2023.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
In this review, we explore associations between SARS CoV-2 infection and the endocrine system and metabolism in children and adolescents. PubMed, Scopus and Google scholar databases were searched to identify published data on endocrine manifestations of COVID-19 in children up to 31 March 2023, including diabetes, obesity, puberty, thyroid disorders, adrenal disorders and pituitary disorders. Data on changes in disease pattern/ incidence, disease control, and other effects due to the COVID-19 pandemic, as well as effects of pre-existing endocrine conditions on severity of COVID-19 infection are presented, and practice points and research needs provided under each section.
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Affiliation(s)
| | | | | | | | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Sri Lanka; Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka.
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Jaques-Albuquerque LT, Dos Anjos-Martins E, Torres-Nunes L, Valério-Penha AG, Coelho-Oliveira AC, da Silva Sarandy VL, Reis-Silva A, Seixas A, Bernardo-Filho M, Taiar R, de Sá-Caputo DC. Effectiveness of Using the FreeStyle Libre ® System for Monitoring Blood Glucose during the COVID-19 Pandemic in Diabetic Individuals: Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13081499. [PMID: 37189600 DOI: 10.3390/diagnostics13081499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Artificial Intelligence (AI) is an area of computer science/engineering that is aiming to spread technological systems. The COVID-19 pandemic caused economic and public health turbulence around the world. Among the many possibilities for using AI in the medical field is FreeStyle Libre® (FSL), which uses a disposable sensor inserted into the user's arm, and a touchscreen device/reader is used to scan and retrieve other continuous monitoring of glucose (CMG) readings. The aim of this systematic review is to summarize the effectiveness of FSL blood glucose monitoring during the COVID-19 pandemic. METHODS This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and was registered in the international prospective register of systematic reviews (PROSPERO: CRD42022340562). The inclusion criteria considered studies involving the use of the FSL device during the COVID-19 pandemic and published in English. No publication date restrictions were set. The exclusion criteria were abstracts, systematic reviews, studies with patients with other diseases, monitoring with other equipment, patients with COVID-19, and bariatrics patients. Seven databases were searched (PubMed, Scopus, Embase, Web of Science, Scielo, PEDro and Cochrane Library). The ACROBAT-NRSI tool (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies) was used to evaluate the risk of bias in the selected articles. RESULTS A total of 113 articles were found. Sixty-four were excluded because they were duplicates, 39 were excluded after reading the titles and abstracts, and twenty articles were considered for full reading. Of the 10 articles analyzed, four articles were excluded because they did not meet the inclusion criteria. Thus, six articles were included in the current systematic review. It was observed that among the selected articles, only two were classified as having serious risk of bias. It was shown that FSL had a positive impact on glycemic control and on reducing the number of individuals with hypoglycemia. CONCLUSION The findings suggest that the implementation of FSL during COVID-19 confinement in this population can be confidently stated to have been effective in diabetes mellitus patients.
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Affiliation(s)
- Luelia Teles Jaques-Albuquerque
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Elzi Dos Anjos-Martins
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Luiza Torres-Nunes
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Ana Gabriellie Valério-Penha
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Ana Carolina Coelho-Oliveira
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Viviani Lopes da Silva Sarandy
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Aline Reis-Silva
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Adérito Seixas
- Escola Superior de Saúde Fernando Pessoa, 4200-256 Porto, Portugal
| | - Mario Bernardo-Filho
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Redha Taiar
- MATériaux et Ingénierie Mécanique (MATIM), Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Danúbia Cunha de Sá-Caputo
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Policlínica Universitária Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
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Zucchini S, Scozzarella A, Maltoni G. Multiple influences of the COVID-19 pandemic on children with diabetes: Changes in epidemiology, metabolic control and medical care. World J Diabetes 2023; 14:198-208. [PMID: 37035223 PMCID: PMC10075036 DOI: 10.4239/wjd.v14.i3.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/28/2023] [Accepted: 02/23/2023] [Indexed: 03/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has heavily affected health worldwide, with the various forms of diabetes in children experiencing changes at various levels, including epidemiology, diabetic ketoacidosis rates and medical care. Type 1 diabetes showed an apparent increase in incidence, possibly owing to a direct damage of the virus to the β-cell. Diabetic ketoacidosis also increased in association with the general fear of referring patients to the hospital. Most children with diabetes (both type 1 and type 2) did not show a worsening in metabolic control during the first lockdown, possibly owing to a more controlled diet by their parents. Glucose sensor and hybrid closed loop pump technology proved to be effective in all patients with type 1 diabetes during the pandemic, especially because the downloading of data allowed for the practice of tele-medicine. Telemedicine has in fact grown around the world and National Health Systems have started to consider it as a routine activity in clinical practice. The present review encompasses all the aspects related to the effects of the pandemic on the different forms of diabetes in children.
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Affiliation(s)
- Stefano Zucchini
- Department of Pediatric, IRCCS AOU di Bologna, Bologna 40138, Italy
| | | | - Giulio Maltoni
- Department of Pediatric, IRCCS AOU di Bologna, Bologna 40138, Italy
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Tremolada M, Cusinato M, D’Agnillo A, Negri A, Righetto E, Moretti C. "One and a Half Years of Things We Could Have Done": Multi-Method Analysis of the Narratives of Adolescents with Type 1 Diabetes during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2620. [PMID: 36767985 PMCID: PMC9916259 DOI: 10.3390/ijerph20032620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Public health interventions for COVID-19 forced families to adopt changes in daily routines that affected children's and adolescents' psychological well-being. In youth with type 1 diabetes (T1D), psychological symptoms may compromise glycemic control and outcomes; however, evidence of improved glycemic control in children and adolescents with T1D emerged early during the pandemic. This qualitative study aims to provide a more in-depth understanding of how the COVID-19 pandemic affected adolescents' with T1D routines, experiences, T1D management, and psychological well-being. METHODS 24 adolescents, aged 15-18 years, with T1D, joined focus-group discussions during the diabetes summer camp. Word frequency analysis and thematic analysis were conducted on adolescents' narratives. The average frequencies of use of words related to COVID-19 and to T1D were compared by t-test. RESULTS Word frequency analysis identified "friends", "family", and "home" as the most recurrent terms. Seven themes were highlighted: (1) COVID-19 and T1D; (2) emotional reactions to the COVID-19 pandemic; (3) changes in daily life; (4) feelings of loss; (5) coping with the COVID-19 pandemic; (6) the COVID-19 pandemic as opportunity; (7) return to (new) normality. COVID-19 related words were on average more frequent than words referring to T1D. CONCLUSIONS The COVID-19 pandemic may have represented a more stressful condition for adolescents with T1D, facing additional challenges compared to their healthy peers. Findings offer directions to the diabetes care team for customized interventions while the effects of the pandemic on adolescents' health continue.
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Affiliation(s)
- Marta Tremolada
- Department of Developmental Psychology and Socialization, University of Padova, 35131 Padua, Italy
| | - Maria Cusinato
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Alessia D’Agnillo
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Arianna Negri
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Elena Righetto
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Carlo Moretti
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padua, Italy
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Han Y, Chen Y, Sun C, Zhou Z. The impact of COVID lockdown on glycaemic control in paediatric patients with type 1 diabetes: A systematic review and meta-analysis of 22 observational studies. Front Endocrinol (Lausanne) 2022; 13:1069559. [PMID: 36531473 PMCID: PMC9748149 DOI: 10.3389/fendo.2022.1069559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction The COVID lockdown has posted a great challenge to paediatric patients with type 1 diabetes (T1D) and their caregivers on the disease management. This systematic review and meta-analysis sought to compare the glycaemic control among paediatric patients with T1D (aged under 18 years) pre- during, and post-lockdown period. Methods and materials We did a systematic search of three databases (PubMed, Embase, and the WHO COVID-19 Global literature) for the literature published between 1 Jan 2019 to 10 Sep 2022. Studies meeting the following inclusion criteria were eligible for this study: (1) a COVID-19 related study; (2) inclusion of children aged 18 years old or under with established T1D; (3) comparing the outcomes of interest during or after the COVID lockdown with that before the lockdown. Study endpoints included mean difference (MD) in HbA1c, blood glucose, time in range (TIR, 70-180 mg/dl), time above range (TAR, >180mg/dl), time below range (TBR,<70mg/dl) and glucose variability (coefficient of variation [CV]) between pre-lockdown and during lockdown and/or between pre- and post-lockdown period. The MD and its corresponding 95% CI of each endpoint were pooled using random-effect model considering the potential between-study heterogeneity in COVID restrictions and T1D management. Results Initial search identified 4488 records and 22 studies with 2106 paediatric patients with T1D were included in the final analysis. Compared with pre-lockdown period, blood glucose was significantly decreased by 0.11 mmol/L (95%CI: -0.18, -0.04) during lockdown period and by 0.42 mmol/L (95%CI: -0.73, -0.11) after lockdown. The improvement was also found for TIR, TAR, TBR, and CV during and post-lockdown (all p values<0.05) except for the post-lockdown TBR (p =0.35). No significant change in HbA1c was observed during and post- lockdown period when compared with the pre-lockdown value. There was moderate to high between-study heterogeneity for most of the analyses. Conclusion Compared with pre-lockdown period, there was significant improvement in T1D paediatric patients' glucose metrics during and post-lockdown. The underlying reasons for this positive impact warrant further investigation to inform future paediatric diabetes management. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022359213.
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Affiliation(s)
- Yanping Han
- Department of Endocrinology and Metabolism, Anhui Provincial Children’s Hospital, Hefei, Anhui, China
| | - Yuqing Chen
- Department of Endocrinology and Metabolism, Anhui Provincial Children’s Hospital, Hefei, Anhui, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, University of Illinois College of Medicine, Chicago, IL, United States
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Rajan R, Athale U, Ewusie JE, McAssey K, Thabane L, Samaan MC. An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study. Front Pediatr 2022; 10:1038345. [PMID: 36467474 PMCID: PMC9716184 DOI: 10.3389/fped.2022.1038345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic led to substantial shifts in pediatric diabetes care delivery to virtual and hybrid models. It is unclear if these changes in care delivery impacted short-term patient outcomes. Objectives We aimed to explore glycemic control and other diabetes-related outcomes in children living with Type 1 Diabetes Mellitus (T1DM) during the first year of the COVID-19 pandemic at a tertiary pediatric academic center in Canada. Subjects Patients <18 years of age with a confirmed diagnosis of T1DM for at least one year were included. Methods This was a retrospective chart review. We compared data from two years pre-pandemic (March 15, 2018-March 14, 2020) to the first year of the pandemic (March 15, 2020-March 14, 2021). The data assessed included glycemic control [Hemoglobin A1c (HbA1c)], diabetic ketoacidosis (DKA), hospital attendance and hospitalizations, hypoglycemia, and hyperglycemia. The generalized estimating equation (GEE) analysis was used to model potential factors affecting the HbA1c and diabetes-related morbidities. Multiple imputations were conducted as a sensitivity analysis. Results There were 346 eligible patients included in the study. The HbA1c remained stable during the pandemic compared to the pre-pandemic phase (MD-0.14, 95% CI, -0.28, 0.01; p = 0.058). The pandemic saw an increase in the number of newly diagnosed patients (X2 = 16.52, p < 0.001) and a higher number of newly diagnosed patients presenting in DKA (X2 = 12.94, p < 0.001). In patients with established diabetes, there was an increase in hyperglycemia (OR1.38, 95% CI, 1.12,1.71; p = 0.003) and reduced DKA (OR 0.30, 95% CI, 0.12,0.73; p = 0.009) during the pandemic compared to the pre-pandemic phase. Stable rates of hospitalization (OR0.57, 95% CI, 0.31,1.04, p = 0.068) and hypoglycemia (OR1.11, 95% CI, 0.83,1.49; p = 0.484) were noted. These results were retained in the sensitivity analysis. Conclusions Glycemic control in children with T1DM remained stable during the first year of the pandemic. There were more newly diagnosed patients during the pandemic compared to the pre-pandemic phase, and more of these new patients presented in DKA. The latter presentation was reduced in those with established diabetes during the same period.Further studies are needed to assess the ongoing impact of the COVID-19 pandemic on T1DM care pathways and outcomes to allow children, families, and diabetes teams to personalize choices of care models.
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Affiliation(s)
- Raeesha Rajan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Hematology Oncology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Joycelyne Efua Ewusie
- The Research Institute Biostatistics Unit,St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Karen McAssey
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute Biostatistics Unit,St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Centre for Evaluation of Medicines, Hamilton, ON, Canada
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Kaushal T, Tinsley LJ, Volkening LK, Turcotte C, Laffel LM. Improved CGM Glucometrics and More Visits for Pediatric Type 1 Diabetes Using Telemedicine During 1 Year of COVID-19. J Clin Endocrinol Metab 2022; 107:e4197-e4202. [PMID: 35948357 PMCID: PMC9516076 DOI: 10.1210/clinem/dgac476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The COVID-19 pandemic led to rapid adoption of telemedicine for the care of youth with type 1 diabetes (T1D). We assessed the utility of a primarily virtual care model by comparing glucometrics from a pediatric sample with T1D using continuous glucose monitoring (CGM) both before and during the pandemic. METHODS Pediatric patients aged 1 to 17 years with T1D duration ≥ 1 year if ≥ 6 years old or ≥ 6 months if < 6 years old, with ≥ 1 visit with recorded CGM data both prepandemic (April 1, 2019-March 15, 2020) and during the pandemic (April 1, 2020-March 15, 2021) were included. Data were extracted from the electronic health record. RESULTS Our sample comprised 555 young people (46% male, 87% White, 79% pump-treated), mean age 12.3 ± 3.4 years, T1D duration 5.9 ± 3.5 years, baseline glycated hemoglobin A1c 8.0 ± 1.0% (64 ± 10.9 mmol/mol). Diabetes visit frequency increased from 3.8 ± 1.7 visits/prepandemic period to 4.3 ± 2.2 visits/pandemic period (P < 0.001); during pandemic period, 92% of visits were virtual. Glucose management indicator (GMI) improved slightly from 7.9% (63 mmol/mol) prepandemic to 7.8% (62 mmol/mol) during the pandemic (P < 0.001). Those with equal or greater visit frequency (n = 437 [79% of sample]) had significant improvement in GMI (8.0% to 7.8% [64 to 62 mmol/mol], P < 0.001), whereas those with lower visit frequency did not (7.8 [62 mmol/mol], P = 0.86). CONCLUSIONS Children and adolescents with T1D using CGM before and during the pandemic showed an overall increase in visit frequency using primarily telemedicine-based care and improved CGM glucometrics. Further research is needed to understand factors associated with successful use of telemedicine for pediatric T1D.
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Pica S, Morano C, Díez LR. A role for the diabetes nurse educator to telemedically support children with type 1 diabetes on continuous glucose monitoring? The COVID-19 lockdown experience. Prim Care Diabetes 2022; 16:365-367. [PMID: 35351390 DOI: 10.1016/j.pcd.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
The role of diabetes nurse educators during the COVID-19 lockdown to telematically provide routine reviews of glycaemic control in children with type 1 diabetes (T1D) using continuous glucose monitoring systems is evaluated. Implementing these routines in the day-to-day clinical practice could reduce in-person clinic visits and improve glucose control.
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Affiliation(s)
- Susana Pica
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Spain.
| | - Carmen Morano
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Spain.
| | - Luis-Rogelio Díez
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain.
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Hakonen E, Varimo T, Tuomaala AK, Miettinen PJ, Pulkkinen MA. The effect of COVID-19 lockdown on the glycemic control of children with type 1 diabetes. BMC Pediatr 2022; 22:48. [PMID: 35045807 PMCID: PMC8766349 DOI: 10.1186/s12887-022-03115-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background Between March 18th and May 13th 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare (i.e. lockdown). Social distancing changed the daily routines of children with type 1 diabetes (T1D). Healthcare professionals were forced to adapt to the pandemic by replacing physical outpatient visits with virtual visits. However, the influence of the lockdown on glycemic control in these patients remained unknown. Methods In this retrospective register study from a pediatric diabetes outpatient clinic, we analyzed the glycemic data of T1D patients (n = 245; aged 4 to 16 years) before and under the lockdown. All the participants used continuous glucose monitoring (rtCGM or iCGM), two-thirds were on insulin pumps (CSII), and one-third on multiple daily insulin injections (MDI) therapy. Results In our patient cohort, time in range (TIR, n = 209) and mean glucose levels (n = 214) were similar prior to and under the lockdown (mean change 0.44% [95%CI: -1.1–2.0], p = 0.56 and -0.13 mmol/mol [95%CI: -0.3–0.1], p = 0.17, respectively). However, children treated with CSII improved their glycemic control significantly during the lockdown: TIR improved on average 2.4% [0.6–4.2] (p = 0.010) and mean blood glucose level decreased -0.3 mmol/mol [-0.6-(-0.1)] (p = 0.008). The difference was more pronounced in girls, adolescents and patients using conventional insulin pumps. Conclusions The glycemic control in T1D children did not deteriorate under the lockdown, and patients on CSII even improved their control, which suggests that social distancing might have allowed families to use the insulin pump more accurately as out-of-home activities were on hold.
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Duarte V, Mota B, Ferreira S, Costa C, Correia CC. Impact of COVID-19 lockdown on glycemic control in type 1 diabetes. Arch Pediatr 2021; 29:27-29. [PMID: 34955306 PMCID: PMC8660259 DOI: 10.1016/j.arcped.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022]
Abstract
Aim The COVID-19 pandemic has forced governments to impose lockdown policies, thus impacting patients with chronic diseases, such as type 1 diabetes. The aim of this study was to evaluate the impact of lockdown on glycemic control in type 1 diabetes patients. Patients and methods We retrospectively evaluated patients using a continuous subcutaneous insulin infusion device during the nationwide lockdown. Children and adolescents aged 2–18 years followed up at the Pediatric Endocrinology Unit of Hospitalar São João in Portugal were included in the study. We collected data on the age, weight, insulin doses, and glycemic control of the patients before and after the restrictions. Results The study included 100 patients, 59 males, with a mean age of 12.5 years. Baseline data showed a suboptimal glycemic control with a median HbA1c of 7.9%. The lockdown was associated with an increase in the body mass index (BMI) of all patients (p = 0.009), particularly girls and older teenagers. Metabolic control deteriorated in the 10–13 age group (p = 0.03), with a 0.4% increase in HbA1c. Conclusion To date, this is the largest study on the impact of lockdown on type 1 diabetes in patients using an insulin pump. The results highlight the importance of physical activity, parental supervision, and continuation of healthcare assistance through telemedicine in young individuals with type 1 diabetes.
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Affiliation(s)
- Vitória Duarte
- Endocrinology Department, Armed Forces Hospital, Lisbon, Portugal.
| | - Bárbara Mota
- Pediatric Endocrinology Unit, Centro Hospitalar São João (CHSJ), Portugal
| | - Sofia Ferreira
- Pediatric Endocrinology Unit, Centro Hospitalar São João (CHSJ), Portugal
| | - Carla Costa
- Pediatric Endocrinology Unit, Centro Hospitalar São João (CHSJ), Portugal
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Lazzeroni P, Motta M, Monaco S, Laudisio SR, Furoncoli D, Maffini V, Rubini M, Tchana B, Ruberto C, Dodi I, Iovane B. Improvement in glycaemic control in paediatric and young adult type 1 diabetes patients during COVID-19 pandemic: role of telemedicine and lifestyle changes. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021399. [PMID: 34738562 PMCID: PMC8689301 DOI: 10.23750/abm.v92i5.11911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM COVID-19 pandemic determined a profound impact in everyday life and in routine follow-up of patients with type 1 diabetes (T1D). In this context, telemedicine represented an important tool to guarantee a regular care for these patients. Aim of our work was to assess metabolic control before and after lockdown in the cohort of T1D patients followed-up by our Service, to evaluate the impact of restrictive measures and of disease management through telemedicine. METHODS This is a retrospective observational study. Subjects were enrolled among children, adolescents and young adults affected by T1D and followed at the Regional Paediatric Diabetology Centre of the University-Hospital of Parma, Italy. We collected data about age, gender, ethnicity, anthropometric measurements, duration of disease, type of blood glucose monitoring used, type of insulin administration, daily insulin requirement and metabolic control, assessed using capillary HbA1c. RESULTS We enrolled 139 patients, mean age 13.9 years. During lockdown, we reported significantly more contacts through telemedicine between patients and medical team. Global glycol-metabolic control significantly improved, without differences in daily insulin requirement. Patients with a previous poor-controlled diabetes showed a greater improvement. Finally, mean weekly hours of physical activity decreased significantly, without worsening in BMI z-score. CONCLUSIONS Our results show a global improvement in mean HbA1c, with a stronger result for patients with a previous non satisfactory control. In our setting, despite regulatory rules and physical and logistic limitations related to pandemic, no worsening of metabolic control has been shown for patients with type 1 diabetes.
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Affiliation(s)
- Pietro Lazzeroni
- Centre for Diabetes in Children and Adolescents, Department of Woman and Child Health, Parma University Hospital, Parma, Italy.
| | - Matteo Motta
- Post-graduate School of Pediatrics, University of Parma, Parma, Italy.
| | - Sara Monaco
- Post-graduate School of Pediatrics, University of Parma, Parma, Italy.
| | | | - Daria Furoncoli
- Centre for Diabetes in Children and Adolescents, Department of Woman and Child Health, Parma University Hospital, Parma, Italy.
| | - Valentina Maffini
- Department of Woman and Child Health, Parma University Hospital, Parma, Italy.
| | - Monica Rubini
- Department of Woman and Child Health, Parma University Hospital, Parma, Italy.
| | - Bertrand Tchana
- Department of Woman and Child Health, Parma University Hospital, Parma, Italy.
| | - Claudio Ruberto
- Department of Woman and Child Health, Parma University Hospital, Parma, Italy.
| | - Icilio Dodi
- Department of Woman and Child Health, Parma University Hospital, Parma, Italy.
| | - Brunella Iovane
- Centre for Diabetes in Children and Adolescents, Department of Woman and Child Health, Parma University Hospital, Parma, Italy.
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Eberle C, Stichling S. Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review. Diabetol Metab Syndr 2021; 13:95. [PMID: 34493317 PMCID: PMC8423337 DOI: 10.1186/s13098-021-00705-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2019, a new virus known as severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has emerged. Coronavirus disease 2019 (COVID-19) was classified as a pandemic in a short period of time. In order to reduce the spread of COVID-19, many countries have imposed a lockdown with movement restrictions, social distancing and home confinement, which has affected routine healthcare activities and everyday life. The aim of this systematic review was to examine the impact of the COVID-19 lockdown on glycemic control in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS We systematically identified studies by searching the databases Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, EMBASE, and CINAHL until April 2021. We included n = 33 observational studies of which n = 25 investigated T1D and n = 8 T2D. RESULTS Overall, we analyzed n = 2881 T1D patients and n = 1823 T2D patients. Glycemic values in patients with T1D improved significantly during lockdown. Overall, n = 18 (72%) T1D studies indicated significant improvements in glycemic outcomes. Meta-analysis revealed a mean difference in HbA1c of - 0.05% (95% CI - 0.31 to 0.21) due to lockdown, and in time in range (TIR) of + 3.75% (95% CI 2.56 to 4.92). Lockdown determined a short-term worsening in glycemic values in patients with T2D. Overall, n = 4 (50%) publications observed deteriorations in glycemic control. Meta-analysis demonstrated a mean difference in HbA1c of + 0.14 (95% CI - 0.13 to 0.40) through the lockdown. Moreover, n = 3 (75%) studies reported a not significant deterioration in body weight. CONCLUSIONS Glycemic values in people with T1D significantly improved during COVID-19 lockdown, which may be associated with positive changes in self-care and digital diabetes management. In contrast, lockdown rather determined a short-term worsening in glycemic parameters in patients with T2D. Further research is required, particularly into the causes and effective T2D management during lockdown.
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Affiliation(s)
- Claudia Eberle
- Medicine With Specialization in Internal Medicine and General Medicine, Hochschule Fulda-University of Applied Sciences, Leipziger Strasse 123, 36037, Fulda, Germany.
| | - Stefanie Stichling
- Medicine With Specialization in Internal Medicine and General Medicine, Hochschule Fulda-University of Applied Sciences, Leipziger Strasse 123, 36037, Fulda, Germany
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