Reduction of hypoglycaemia, lifestyle modifications and psychological distress during lockdown following SARS-CoV-2 outbreak in type 1 diabetes.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100883450 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1520-7560 (Electronic) Linking ISSN: 15207552 NLM ISO Abbreviation: Diabetes Metab Res Rev Subsets: MEDLINE

Original Publication: Oxford, England : Wiley-Blackwell, c1999-

Communicable Disease Control* ; Diabetes Mellitus, Type 1*/blood ; Diabetes Mellitus, Type 1*/epidemiology ; Diabetes Mellitus, Type 1*/psychology ; Diabetes Mellitus, Type 1*/therapy; COVID-19/*prevention & control ; Hypoglycemia/*epidemiology ; Stress, Psychological/*epidemiology; Adolescent ; Adult ; Behavior Therapy/statistics & numerical data ; Blood Glucose Self-Monitoring ; COVID-19/epidemiology ; Disease Outbreaks ; Female ; Humans ; Hypoglycemia/blood ; Italy/epidemiology ; Life Style ; Male ; Middle Aged ; Pandemics ; Patient Compliance/psychology ; Patient Compliance/statistics & numerical data ; Psychological Distress ; Quarantine/statistics & numerical data ; Remote Consultation ; Retrospective Studies ; SARS-CoV-2 ; Stress, Psychological/etiology ; Young Adult

Aims: To assess changes in glucose metrics and their association with psychological distress and lifestyle changes in patients with type 1 diabetes (T1D) using flash glucose monitoring (FGM) during lockdown following severe acute respiratory syndrome coronavirus 2 outbreak.
Materials and Methods: Single-centre, observational, retrospective study enrolling T1D patients who attended a remote visit on April 2020 at the Endocrinology division of the University Hospital Policlinico Consorziale, Bari, Italy. Lockdown-related changes in physical activity level and dietary habits were assessed on a semi-quantitative basis. Changes in general well-being were assessed by the General Health Questionnaire-12 items with a binary scoring system. Glucose metrics were obtained from the Libreview platform for the first 2 weeks of February 2020 (T0) and the last 2 weeks before the phone visit (T1).
Results: Out of 84 patients assessed for eligibility, 48 had sufficient FGM data to be included in the analysis. FGM data analysis revealed significant reductions in coefficient of variation, number of hypoglycaemic events, and time below range, while no changes were found in time in range, time above range, mean sensor glucose, and glucose management indicator. Moreover, the frequency of sweets consumption was inversely related to the occurrence of hypoglycaemic events during lockdown.
Conclusions: Lockdown-related lifestyle changes, albeit unhealthy, may lead to reduction in FGM-derived measures of hypoglycaemia and glycaemic variability in patients with T1D.
(© 2020 John Wiley & Sons Ltd.)

Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet. 2020;395(10231):1225-1228. http://dx.doi.org/10.1016/s0140-6736(20)30627-9.
Wikipedia. 2020 Coronavirus pandemic in Italy. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy.
Istituto Superiore di Sanità. COVID-19: Healthy lifestyles also during the emergency. https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-healthy-lifestyles.
Wang C, Pan R, Wan X, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1729. https://doi.org/10.3390/ijerph17051729.
González-Sanguino C, Ausín B, Ángel Castellanos M, et al. Mental health consequences during the initial stage of the 2020 coronavirus pandemic (COVID-19) in Spain. Brain Behav Immun. 2020;87:172-176. https://doi.org/10.1016/j.bbi.2020.05.040.
American Diabetes Association. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43:S48-S65.
Joubert M, Benhamou PY, Schaepelynck P, et al. Remote monitoring of diabetes: a Cloud-Connected Digital System for individuals with diabetes and their health care providers. J Diabetes Sci Technol. 2019;13(6):1161-1168. https://doi.org/10.1177/1932296819834054.
Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline JP, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther. 2017;8(1):55-73. https://doi.org/10.1007/s13300-016-0223-6.
Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet. 2016;388(10057):2254-2263. https://doi.org/10.1016/s0140-6736(16)31535-5.
Bruttomesso D, Laviola L, Avogaro A, et al. The use of real time continuous glucose monitoring or flash glucose monitoring in the management of diabetes: a consensus view of Italian diabetes experts using the Delphi method. Nutr Metab Cardiovasc Dis. 2019;29(5):421-431. https://doi.org/10.1016/j.numecd.2019.01.018.
Johnson ML, Martens TW, Criego AB, Carlson AL, Simonson GD, Bergenstal RM. Utilizing the ambulatory glucose profile to standardize and implement continuous glucose monitoring in clinical practice. Diabetes Technol Ther. 2019;21(S2):S217-S225. https://doi.org/10.1089/dia.2019.0034.
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. https://doi.org/10.1007/s13300-020-00829-7.
Beato-Víbora PI. No deleterious effect of lockdown due to COVID-19 pandemic on glycaemic control, measured by glucose monitoring, in adults with type 1 diabetes. Diabetes Technol Ther. 2020;22(8):643. https://doi.org/10.1089/dia.2020.0184.retract.
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. https://doi.org/10.1089/dia.2020.0169.
Sánchez-López MDP, Dresch V. The 12-item General Health Questionnaire (GHQ-12): reliability, external validity and factor structure in the Spanish population. Psicothema. 2008;20(4):839-843.
Qiu S, Sun XH, Liu WY, et al. Prevalence and correlates of psychological distress among diabetes mellitus adults in the Jilin province in China: a cross-sectional study. PeerJ. 2017;2017:1-17. https://doi.org/10.7717/peerj.2869.
Phillips MR, Zhang J, Shi Q, et al. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey. Lancet. 2009;373(9680):2041-2053.
Cuschieri S, Grech S. Journal of Diabetes and its Complications COVID-19 and diabetes : the why, the what and the how. J Diabetes Complications. 2020;34(9):107637. https://doi.org/10.1016/j.jdiacomp.2020.107637.
Nusca A, Tuccinardi D, Albano M, et al. Glycemic variability in the development of cardiovascular complications in diabetes. Diabetes Metab Res Rev. 2018;34(8):1-10. https://doi.org/10.1002/dmrr.3047.
Nusca A, Tuccinardi D, Proscia C, et al. Incremental role of glycaemic variability over HbA1c in identifying type 2 diabetic patients with high platelet reactivity undergoing percutaneous coronary intervention. Cardiovasc Diabetol. 2019;18(1):1-9. https://doi.org/10.1186/s12933-019-0952-8.
Xing D, Kollman C, Beck RW, et al. Optimal sampling intervals to assess long-term glycemic control using continuous glucose monitoring. Diabetes Technol Ther. 2011;13(3):351-358. https://doi.org/10.1089/dia.2010.0156.
Riddlesworth TD, Beck RW, Gal RL, et al. Optimal sampling duration for continuous glucose monitoring to determine long-term glycemic control. Diabetes Technol Ther. 2018;20(4):314-316. https://doi.org/10.1089/dia.2017.0455.
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. https://doi.org/10.2337/dc200954.
Pulvirenti F, Cinetto F, Milito C, et al. Health-related quality of life in common variable immunodeficiency Italian patients switched to remote assistance during the COVID-19 pandemic. J Allergy Clin Immunol Pract. 2020;2(6):1894-1899.e2. https://doi.org/10.1016/j.jaip.2020.04.003.
Gallè F, Sabella EA, Da Molin G, et al. Understanding knowledge and behaviors related to CoViD-19 epidemic in Italian undergraduate students: the EPICO study. Int J Environ Res Public Health. 2020;17(10):3481. https://doi.org/10.3390/ijerph17103481.

Keywords: COVID-19; FGM; hypoglycaemia; lifestyle; lockdown; type 1 diabetes

Date Created: 20200912 Date Completed: 20210917 Latest Revision: 20210917

20231215

10.1002/dmrr.3404

32918324