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Italy’s COVID-19 Lockdown Boosted T1D Glycemic Control

Glycemic control among patients with type 1 diabetes (T1D) in Italy improved during the pandemic lockdown there, a small study found.

In an analysis of 20 Italians with T1D who stopped work during the COVID-19 pandemic lockdown, glycemic control significantly improved within just the first week, reported Federico Boscari, MD, of the University of Padova, and colleagues.

Specifically, mean blood glucose declined from 177 ± 45 mg/dL (9.9 ± 2.5 mmol/L) in the week just before lockdown to 160 ± 40 mg/dL (8.9 ± 2.2 mmol/L) during the first 7 days in lockdown in March 2020 (P=0.005).

The findings were presented at the virtual European Association for the Study of Diabetes 2020 meeting and also published in Diabetes Therapy.

“This suggests that slowing down routine activities can have a positive effect on glycemic control in the short term,” Boscari said during a press conference.

The benefits also extended to greater time spent in range — hovering between 70 and 180 mg/dL — jumping from about 54.4% of time spent in range up to 65.2% of time spent in range during lockdown.

These patients simultaneously saw a significant drop in the time spent in hyperglycemia — with levels over 180 mg/dL — decreasing from 42.3% to 31.6% of time (P=0.016), Boscari reported.

However, time spent in hypoglycemia didn’t change significantly, and the number of scans per day recorded showed no change (12.6 ± 2.4 to 13.4 ± 2.9, P= 0.479).

Boscari said that data was also collected on 13 people with T1D who were considered essential workers and therefore continued to work throughout the lockdown, but none of these individuals had changes in glycemic measures.

He pointed out that despite the significant improvement in the percentage of time spent in range for the patients who stopped working during the lockdown — reaching 65% — the 13 patients who continued working started with about a 65% time spent in range prior to lockdown.

During the first full week, essential workers spent an average 68% of time in range. The reason for this, Boscari said, was that the 20 nonessential workers were on multiple daily injections of insulin, whereas the majority of the essential workers were on continuous subcutaneous insulin infusions, resulting in a higher baseline time spent in range.

All 33 individuals in the analysis were patients at a diabetes outpatient clinic of the University Hospital of Padova and resided locally. All the patients were also using the FreeStyle Libre flash glucose-monitoring system for a minimum of 3 months prior to the lockdown. The glucose-monitoring data was shared to the diabetes clinic and saved on a web-based cloud system called Freestyle LibreView.

The researchers compared the glycemic measures taken during the first week of complete lockdown with the data taken 3 months prior to the COVID-19 outbreak. The team also collected measurements during an intermediate period when Italy closed only educational and sporting activities, with the country not yet on full lockdown.

During that intermediary “soft closure” period, glucose measures were not significantly different from the time prior to the outbreak, suggesting that the glycemic benefit directly stemmed from patients stopping work and other routine activities, Boscari said.

In addition, he said, the team used glucose readings only from the first full week of lockdown and did not include data from subsequent weeks, since all patients were contacted by their healthcare providers about how to manage their T1D during lockdown, with possible introduction of bias in the data.

Another limitation, he said, was that the study was small and included only patients with reasonably decent metabolic profiles prior to lockdown, so the findings are not generalizable to patients with poor glycemic control.

  • Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and dermatology news. Based out of the New York City office, she’s worked at the company for nearly five years.

Disclosures

Boscari and other study authors reported relationships with Abbott, the manufacturer of the flash glucose monitoring system and cloud platform described in the study.

Source: MedicalNewsToday.com