Comparison of the effects of lockdown due to COVID-19 on glucose patterns among children, adolescents, and adults with type 1 diabetes: CGM study

IntroductionThe COVID-19 pandemic forced the Italian government to issue extremely restrictive measures on daily activities since 11 March 2020 (‘lockdown’), which may have influenced the metabolic control of type 1 diabetes mellitus (T1D). The aims of the study were to investigate continuous glucose monitoring (CGM) metrics in children and adults with T1D during lockdown and to identify their potentially related factors.Research design and methodsWe enrolled 130 consecutive patients with T1D (30 children (≤12 years), 24 teenagers (13–17 years), and 76 adults (≥18 years)) using either Dexcom or FreeStyle LibreCGM>70% during the study period, without hybrid closed-loop insulin pump. CGM metrics during the 20 days before and the 20 days after lockdown were calculated. By telephonic contact, we performed validated physical activity and perceived stress questionnaires.ResultsIn children, significantly lower glucose SD (SDglu) (p=0.029) and time below range (TBR)<54 mg/dL (TBR2) (p=0.029) were detected after lockdown. CGM metrics were comparable in teenagers before and during lockdown. After lockdown, adults improved significantly time in range (TIR) 70–180 mg/dL (p<0.001) and remaining metrics, except percent coefficient of variation and TBR2. In adults, considering the changes in SDglu and TIR occurred before and during lockdown, we identified a group with improved TIR and SDglu who performed more physical activity, one with improved glucose variability who was younger than the other patients, and one with worsened glucose variability who showed higher perceived stress than others.ConclusionIn patients with T1D during lockdown, CGM metrics mostly improved in children and adults, whereas it was unchanged in teenagers. In adults, age, physical activity, and perceived stress may be relevant contributing factors.

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Short-term glucose variability in adults with Type 1 diabetes does not differ between insulin pump and multiple daily injection users – a masked continuous glucose monitoring study in clinical practice

Diabetes & Metabolism ◽

10.1016/j.diabet.2018.05.006 ◽

2020 ◽

Vol 46 (2) ◽

pp. 172-174

Author(s):

E.S. Scott ◽

R.T. McGrath ◽

A.S. Januszewski ◽

G.R. Fulcher ◽

A.J. Jenkins

Keyword(s):

Type 1 Diabetes ◽

Clinical Practice ◽

Insulin Pump ◽

Glucose Monitoring ◽

Glucose Variability ◽

Daily Injection ◽

Short Term ◽

Multiple Daily Injection ◽

Monitoring Study

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Temporal Trends and Contemporary Use of Insulin Pump Therapy and Glucose Monitoring Among Children, Adolescents, and Adults With Type 1 Diabetes Between 1995 and 2017

Diabetes Care ◽

10.2337/dc19-0345 ◽

2019 ◽

Vol 42 (11) ◽

pp. 2050-2056 ◽

Cited By ~ 28

Author(s):

Louisa van den Boom ◽

Beate Karges ◽

Marie Auzanneau ◽

Birgit Rami-Merhar ◽

Eggert Lilienthal ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Pump ◽

Temporal Trends ◽

Glucose Monitoring ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Adolescents And Adults

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Artificial Pancreas Systems and Physical Activity in Patients with Type 1 Diabetes: Challenges, Adopted Approaches, and Future Perspectives

Journal of Diabetes Science and Technology ◽

10.1177/1932296819869310 ◽

2019 ◽

Vol 13 (6) ◽

pp. 1077-1090 ◽

Cited By ~ 6

Author(s):

Sémah Tagougui ◽

Nadine Taleb ◽

Joséphine Molvau ◽

Élisabeth Nguyen ◽

Marie Raffray ◽

...

Keyword(s):

Physical Activity ◽

Type 1 Diabetes ◽

Healthcare Professionals ◽

Therapeutic Option ◽

Artificial Pancreas ◽

Glucose Monitoring ◽

Glucose Variability ◽

Delivery Methods ◽

Current State

Physical activity is important for patients living with type 1 diabetes (T1D) but limited by the challenges associated with physical activity induced glucose variability. Optimizing glycemic control without increasing the risk of hypoglycemia is still a hurdle despite many advances in insulin formulations, delivery methods, and continuous glucose monitoring systems. In this respect, the artificial pancreas (AP) system is a promising therapeutic option for a safer practice of physical activity in the context of T1D. It is important that healthcare professionals as well as patients acquire the necessary knowledge about how the AP system works, its limits, and how glucose control is regulated during physical activity. This review aims to examine the current state of knowledge on exercise-related glucose variations especially hypoglycemic risk in T1D and to discuss their effects on the use and development of AP systems. Though effective and highly promising, these systems warrant further research for an optimized use around exercise.

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947-P: Glucose Variability: Insulin Pump vs. Multiple Daily Injection in Type 1 Diabetes Evaluated by Continuous Glucose Monitoring

Diabetes ◽

10.2337/db19-947-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 947-P

Author(s):

ADRIAN E. PROIETTI ◽

ANDREA V. DAGHERO ◽

MARIA LUJAN SCAPUZZI ◽

MARIA L. IGLESIAS ◽

JUAN PATRICIO NOGUEIRA

Keyword(s):

Type 1 Diabetes ◽

Continuous Glucose Monitoring ◽

Insulin Pump ◽

Glucose Monitoring ◽

Glucose Variability ◽

Daily Injection ◽

Multiple Daily Injection

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Anxiety, depression, and glycemic control during Covid-19 pandemic in youths with type 1 diabetes

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0153 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Maria Cusinato ◽

Mariangela Martino ◽

Alex Sartori ◽

Claudia Gabrielli ◽

Laura Tassara ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Psychological Impact ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Well Being ◽

Glucose Variability ◽

Threshold Score ◽

The Impact

Abstract Objectives Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. Methods We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. Results We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. Conclusions Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation.

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The UVA/Padova Type 1 Diabetes Simulator Goes From Single Meal to Single Day

Journal of Diabetes Science and Technology ◽

10.1177/1932296818757747 ◽

2018 ◽

Vol 12 (2) ◽

pp. 273-281 ◽

Cited By ~ 41

Author(s):

Roberto Visentin ◽

Enrique Campos-Náñez ◽

Michele Schiavon ◽

Dayu Lv ◽

Martina Vettoretti ◽

...

Keyword(s):

Type 1 Diabetes ◽

In Silico ◽

Artificial Pancreas ◽

Real Life ◽

Glucose Monitoring ◽

Glucose Variability ◽

Self Monitoring ◽

Inhaled Insulin ◽

Single Meal

Background: A new version of the UVA/Padova Type 1 Diabetes (T1D) Simulator is presented which provides a more realistic testing scenario. The upgrades to the previous simulator, which was accepted by the Food and Drug Administration in 2013, are described. Method: Intraday variability of insulin sensitivity (SI) has been modeled, based on clinical T1D data, accounting for both intra- and intersubject variability of daily SI. Thus, time-varying distributions of both subject’s basal insulin infusion and insulin-to-carbohydrate ratio were calculated and made available to the user. A model of “dawn” phenomenon based on clinical T1D data has been also included. Moreover, the model of subcutaneous insulin delivery has been updated with a recently developed model of commercially available fast-acting insulin analogs. Models of both intradermal and inhaled insulin pharmacokinetics have been included. Finally, new models of error affecting continuous glucose monitoring and self-monitoring of blood glucose devices have been added. Results: One hundred in silico adults, adolescent, and children have been generated according to the above modifications. The new simulator reproduces the intraday glucose variability observed in clinical data, also describing the nocturnal glucose increase, and the simulated insulin profiles reflect real life data. Conclusions: The new modifications introduced in the T1D simulator allow to extend its domain of validity from “single-meal” to “single-day” scenarios, thus enabling a more realistic framework for in silico testing of advanced diabetes technologies including glucose sensors, new insulin molecules and artificial pancreas.

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