Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy

Abstract

Introduction: In late February 2020, due to the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Italian Government closed down all educational and sport activities. In March, it introduced further measures to stop the spread of coronavirus disease (COVID-19), placing the country in a state of almost complete lockdown. We report the impact of these restrictions on glucose control among people with type 1 diabetes (T1D).

Methods: Data were collected on 33 individuals with T1D who were monitoring their glucose levels using a flash glucose monitoring device and remotely connected to the diabetes clinic on a cloud platform. We retrieved information on average glucose, standard deviation and percentage time in hypoglycaemia (< 70 mg/dl), glucose range (70-180 mg/dl) and hyperglycaemia (> 180 mg/dl). We compared glycaemic measures collected during lockdown to those collected before the SARS-CoV-2 epidemic and to the periods immediately before lockdown.

Results: In 20 patients who had stopped working and were at home as a result of the lockdown, overall glycaemic control improved during the first 7 days of the lockdown as compared to the weeks before the spread of SARS-CoV-2. Average glucose declined from 177 ± 45 mg/dl (week before lockdown) to 160 ± 40 mg/dl (lockdown; p = 0.005) and the standard deviation improved significantly. Time in range increased from 54.4 to 65.2% (p = 0.010), and time in hyperglycaemia decreased from 42.3 to 31.6% (p = 0.016). The number of scans per day remained unchanged. In 13 patients who continued working, none of the measures of glycaemic control changed during lockdown.

Conclusion: Despite the limited possibility to exercise and the incumbent psychologic stress, glycaemic control improved in patients with T1D who stopped working during the lockdown, suggesting that slowing down routine daily activities can have beneficial effects on T1D management, at least in the short term.

Keywords: COVID-19; Education; Epidemic; Sensor; Telemedicine.

© The Author(s) 2020.

Figures

Fig. 1

Changes in glucose control parameters during lockdown. a Timeline of restriction measures. ‘Before’ refers to 1 week before the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in Italy; ‘Period 1’ refers to the time from the closure of all sport and educational activities to lockdown of the Padova area; ‘Period 2’ refers to the first week after lockdown. Panels b– d refer to patients who stayed at home (i.e. stopped working); panels e–g refer to patients who continued working. b, e Box and whisker plots showing changes in average glucose levels of individual patients (lines), with the horizontal line in box indicating the median, the top and bottom of the box indicating the upper and lower quartiles, respectively, and the whiskers indicating range/variability. c, f Change in the two groups of patients in terms of average glucose versus standard deviation (SD) plot. As per convention, cutoffs (dotted lines) are drawn at an average glucose of 150 mg/dl and a SD of 50 mg/dl to define high/low and stable/unstable control, respectively. d, g Percentage time in hypoglycaemia (Hypo; < 70 mg/dl), range (70–180 mg/dl) and hyperglycaemia (Hyper; > 180 mg/dl) in each group. Asterisk (*) indicates significant difference at p < 0.05 between period 2 and before the outbreak.