The Impact of COVID-19 Lockdown on Metabolic Control and Access to Healthcare in People with Diabetes: the CONFI-DIAB Cross-Sectional Study

Lisa Ludwig, Nicolas Scheyer, Thomas Remen, Bruno Guerci, Lisa Ludwig, Nicolas Scheyer, Thomas Remen, Bruno Guerci

Abstract

Introduction: The COVID-19 pandemic led to an international health crisis and restrictions. While the phenotype associated with COVID-19 severity in people with diabetes has rapidly been explored, the impact of restrictive measures, including lockdown, and tertiary care disruption on metabolic control and access to healthcare remained unknown. The aim of our study was to provide a comprehensive assessment on the overall management of diabetes during lockdown, including glucose control, weight changes, health care consumption and use of alternative forms of care such as telemedicine services, in a large sample of patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM).

Methods: A prioritization of a care self-administered questionnaire was sent at the end of the first COVID-19 lockdown to all patients with diabetes routinely followed by diabetologists from the University Hospital of Nancy (France). This observational cross-sectional single-center study focused on data from patients with diabetes who returned the questionnaire along with medical records. The primary outcome was the change in HbA1c levels between the 6 months preceding and the 6 weeks following the lockdown. Data are expressed as numbers (%) or medians (quartiles). This study is registered with ClinicalTrials.gov (NCT04485351).

Results: We analyzed data from 870 patients with diabetes: 549 T2DM (63.1%), 520 males (59.8%), age 65.0 (57.0, 72.0), body mass index 28.6 (25.1, 32.9) and diabetes duration 20.0 (10.0, 30.0) years. HbA1c levels pre- and post-lockdown were respectively 7.7% (7.1, 8.4) and 7.4% (6.8, 8.2), translating into a significant reduction of - 0.1% (- 0.6, 0.15) (p < 0.0001). Stratified analyses suggested a consistent significant reduction of HbA1c independently of diabetes type. HbA1c reduction was significantly different according to weight changes: - 0.3% (- 0.8, 0.0), - 0.1% (- 0.5, 0.1) and - 0.1% (- 0.5, 0.3) for patients who lost, had stable or gained weight, respectively (p = 0.0029). Respectively, 423 (49.4%) and 790 (92.3%) patients did not consult their general practitioner and diabetologist. Blood tests were undergone by 379 (44.8%) patients, 673 (78.3%) did refill their prescriptions, and 269 (32.1%) used teleconsultation services.

Conclusions: Despite the implementation of a lockdown and disruption in healthcare, no deterioration, rather an improvement, in metabolic control was observed in a large sample of patients with T1DM and T2DM.

Keywords: COVID-19; Diabetes; Healthcare consumption; Lockdown; Metabolic control; Telemedicine.

© 2021. The Author(s).

References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017.
    1. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Bio-Medica Atenei Parm. 2020;91(1):157–160.
    1. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2020;94:91–95.
    1. Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019—COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458–464. doi: 10.15585/mmwr.mm6915e3.
    1. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574–1581. doi: 10.1001/jama.2020.5394.
    1. Prise en charge ambulatoire des patients atteints de diabète de type 1 et 2 [Internet]. Haute Autorité de Santé. Disponible sur:
    1. Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health. 2020;5(8):e437–e443. doi: 10.1016/S2468-2667(20)30117-1.
    1. Coronavirus: un tiers des patients aurait renoncé à des soins pendant l’épidémie selon Doctolib | Le Généraliste [Internet]. . 2020. Disponible sur:
    1. Alshareef R, Al Zahrani A, Alzahrani A, Ghandoura L. Impact of the COVID-19 lockdown on diabetes patients in Jeddah, Saudi Arabia. Diabetes Metab Syndr. 2020;14(5):1583–1587. doi: 10.1016/j.dsx.2020.07.051.
    1. Ruiz-Roso MB, Knott-Torcal C, Matilla-Escalante DC, Garcimartín A, Sampedro-Nuñez MA, Dávalos A, et al. COVID-19 Lockdown and changes of the dietary pattern and physical activity habits in a cohort of patients with type 2 diabetes mellitus. Nutrients. 2020;12(8):2327. doi: 10.3390/nu12082327.
    1. Ghosh A, Arora B, Gupta R, Anoop S, Misra A. Effects of nationwide lockdown during COVID-19 epidemic on lifestyle and other medical issues of patients with type 2 diabetes in north India. Diabetes Metab Syndr. 2020;14(5):917–920. doi: 10.1016/j.dsx.2020.05.044.
    1. Önmez A, Gamsızkan Z, Özdemir Ş, Kesikbaş E, Gökosmanoğlu F, Torun S, et al. The effect of COVID-19 lockdown on glycemic control in patients with type 2 diabetes mellitus in Turkey. Diabetes Metab Syndr déc. 2020;14(6):1963–1966. doi: 10.1016/j.dsx.2020.10.007.
    1. Capaldo B, Annuzzi G, Creanza A, Giglio C, De Angelis R, Lupoli R, et al. Blood glucose control during Lockdown for COVID-19: CGM metrics in Italian adults with type 1 diabetes. Diabetes Care. 2020;43(8):e88–e89. doi: 10.2337/dc20-1127.
    1. Bonora BM, Boscari F, Avogaro A, Bruttomesso D, Fadini GP. Glycaemic control among people with type 1 diabetes during Lockdown for the SARS-CoV-2 outbreak in Italy. Diabetes Ther. 2020;11(6):1369–1379. doi: 10.1007/s13300-020-00829-7.
    1. Aragona M, Rodia C, Bertolotto A, Campi F, Coppelli A, Giannarelli R, et al. Type 1 diabetes and COVID-19: the «lockdown effect». Diabetes Res Clin Pract. 2020;170:108468. doi: 10.1016/j.diabres.2020.108468.
    1. Maddaloni E, Coraggio L, Pieralice S, Carlone A, Pozzilli P, Buzzetti R. Effects of COVID-19 Lockdown on Glucose Control: continuous glucose monitoring data from people with diabetes on intensive insulin therapy. Diabetes Care. 2020;43(8):e86–e87. doi: 10.2337/dc20-0954.
    1. Tornese G, Ceconi V, Monasta L, Carletti C, Faleschini E, Barbi E. Glycemic control in type 1 diabetes mellitus during COVID-19 quarantine and the role of in-home physical activity. Diabetes Technol Ther. 2020;22(6):462–467. doi: 10.1089/dia.2020.0169.
    1. Potier L, Hansel B, Larger E, Gautier J-F, Carreira D, Assemien R, et al. Stay-at-home orders during the COVID-19 pandemic, an opportunity to improve glucose control through behavioral changes in type 1 diabetes. Diabetes Care. 2020;44(3):839–843. doi: 10.2337/dc20-2019.
    1. SPF. Bulletin Epidémiologique Hebdomadaire, 12 novembre 2013, n°37–38Journée mondiale du diabète, 14 novembre 2013. Disponible sur: /maladies-et-traumatismes/diabete/bulletin-epidemiologique-hebdomadaire-12-novembre-2013-n-37-38journee-mondiale-du-diabete-14-novembre-2013
    1. Fernández E, Cortazar A, Bellido V. Impact of COVID-19 lockdown on glycemic control in patients with type 1 diabetes. Diabetes Res Clin Pract. 2020;166:108348. doi: 10.1016/j.diabres.2020.108348.
    1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. doi: 10.1016/j.diabres.2019.107843.
    1. Fagot-Campagna A, Weill A, Paumier A, Poutignat N, Fournier C, Fosse S, et al. Que retenir du bilan d’ENTRED 2007–2010?: ENTRED 2007–2010: Which key-points? Médecine Mal Métaboliques. 2010;4(2):212–218. doi: 10.1016/S1957-2557(10)70047-X.
    1. Cariou B, Hadjadj S, Wargny M, Pichelin M, Al-Salameh A, Allix I, et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020;63(8):1500–1515. doi: 10.1007/s00125-020-05180-x.
    1. Wargny M, Gourdy P, Ludwig L, Seret-Bégué D, Bourron O, Darmon P, et al. Type 1 diabetes in people hospitalized for COVID-19: new insights from the CORONADO study. Diabetes Care. 2020;43(11):e174–e177. doi: 10.2337/dc20-1217.
    1. Pellegrini M, Ponzo V, Rosato R, Scumaci E, Goitre I, Benso A, et al. Changes in Weight and Nutritional Habits in Adults with Obesity during the “Lockdown” Period Caused by the COVID-19 Virus Emergency. Nutrients. 2020;12(7). Disponible sur: .
    1. Stay physically active during self-quarantine. Disponible sur: .
    1. Santé Publique France. Physical activity and sedentary behaviour of french adults during the covid-19 lockdown: an overview of prevalence and perceived evolutions (COVIPREV, 2020).—Bulletin épidémiologique hebdomadaire. 2020. Disponible sur: .
    1. Duclos M, Oppert J-M, Verges B, Coliche V, Gautier J-F, Guezennec Y, et al. Physical activity and type 2 diabetes. Recommandations of the SFD (Francophone Diabetes Society) diabetes and physical activity working group. Diabetes Metab. 2013;39(3):205–216. doi: 10.1016/j.diabet.2013.03.005.
    1. Cuschieri S. COVID-19 panic, solidarity and equity—the Malta exemplary experience. Z Gesundheitswissenschaften. 2020 doi: 10.1007/s10389-020-01308-w.
    1. Jones MS, Goley AL, Alexander BE, Keller SB, Caldwell MM, Buse JB. Inpatient transition to virtual care during COVID-19 Pandemic. Diabetes Technol Ther. 2020;22(6):444–448. doi: 10.1089/dia.2020.0206.
    1. Kanc K, Komel J, Kos M, Wagner J. H(ome)bA1c testing and telemedicine: high satisfaction of people with diabetes for diabetes management during COVID-19 lockdown. Diabetes Res Clin Pract. 2020;166:108285. doi: 10.1016/j.diabres.2020.108285.
    1. Anjana RM, Pradeepa R, Deepa M, Jebarani S, Venkatesan U, Parvathi SJ, et al. Acceptability and utilization of newer technologies and effects on glycemic control in type 2 diabetes: lessons learned from lockdown. Diabetes Technol Ther. 2020;22(7):527–534. doi: 10.1089/dia.2020.0240.
    1. French National Agency for the Safety of Medicines and Health Products. Use of prescription medicines in France during the Covid-19 epidemic: a national review until 25th April 2021. Disponible sur:
    1. Verma A, Rajput R, Verma S, Balania VKB, Jangra B. Impact of lockdown in COVID 19 on glycemic control in patients with type 1 Diabetes Mellitus. Diabetes Metab Syndr. 2020;14(5):1213–1216. doi: 10.1016/j.dsx.2020.07.016.
    1. Kostev K, Kumar S, Konrad M, Bohlken J. Prescription rates of cardiovascular and diabetes therapies prior to and during the COVID-19 lockdown in Germany. Int J Clin Pharmacol Ther. 2020;58(9):475–481. doi: 10.5414/CP203849.
    1. Meier K, Glatz T, Guijt MC, Piccininni M, van der Meulen M, Atmar K, et al. Public perspectives on protective measures during the COVID-19 pandemic in the Netherlands, Germany and Italy: a survey study. PLoS ONE. 2020;15(8):e0236917. doi: 10.1371/journal.pone.0236917.
    1. SPF. Le poids du diabète en France en 2016. Synthèse épidémiologique. Disponible sur: maladies-et-traumatismes/diabete/le-poids-du-diabete-en-france-en-2016.-synthese-epidemiologique

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