COVID-19 lockdown linked to improved glycemic control in type 1 diabetes

A new study looks at changes in the glycemic control in patients with diabetes during the lockdowns implemented to deal with the coronavirus disease 2019 (COVID-19) pandemic. The results of this study show that while there was a significant improvement for people with type 1 diabetes mellitus (DM), the glycemic control waned in patients with type 2 DM.

Study: Impact Of COVID-19 Lockdown on Glycemic Control in Patients with Type 1 And Type 2 Diabetes Mellitus: A Systematic Review. Image Credit: Gecko Studio / Shutterstock.com

Background

The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which is the virus responsible for COVID-19, is a novel coronavirus that emerged in Wuhan, China. Since its original detection in December 2019, SARS-CoV-2 has rapidly spread to many countries around the world and has infected over 225 million people. While a large number of COVID-19 patients are asymptomatic, many more experience mild to moderate illness, with a significant minority developing severe or critical disease, and even death.

Several high-risk factors have been identified that increase the chances of an adverse outcome of COVID-19. One such vulnerability is DM, which affects over 460 million adults worldwide. About 5-10% of diabetics have type 1 diabetes, most of which are children or young adults, making up about 1.1 million individuals worldwide.

The most common form of diabetes is, however, type 2 DM, which comprises up to 90-95% of diabetics. Type 2 DM (T2DM) is associated with increasing age, heavier body mass index (BMI), and a more sedentary lifestyle, all of which can lead to a gradually increasing loss of beta-cell function as a result of insulin resistance.

Conversely, T1DM is an autoimmune condition caused by the destruction of pancreatic beta cells. This destruction prevents the secretion of insulin, thus leading to a complete lack of insulin.

Diabetes increases the mortality rate in COVID-19 patients with acute respiratory distress syndrome (ARDS). Other severe complications are also increased, including microvascular and macrovascular conditions in DM.

The current study examines how diabetes management changed with the onset of lockdowns, social distancing, quarantines, and the shift to the digital practice of medicine. While the first three infection control measures could well have affected the frequency of follow-up visits, exercise, and diet, the last could have benefited diabetes patients by allowing better access to healthcare providers.

Study findings

The researchers found that glycemic control improved significantly among the majority of approximately 2,900 patients with T1DM, with 12% showing a deterioration. The changes in glycosylated hemoglobin (HbA1C) and time in range (TIR) (70–180 mg/dl) from pooled studies were also favorable.

HbA1C values went down significantly, between 0.1% and  0.3%, in 18 studies, while only two studies showed deterioration. One of the latter groups is from India, which showed that HbA1C went down by 1.2% during the lockdown period, mostly due to the inability to obtain insulin or glucometer strips.

The TIR also improved significantly in 83% of the studies; however, no change was observed in the remaining studies.

Conversely, in approximately 1,800 patients with T2DM, almost half the studies showed a clear decrease in glycemic control, while a quarter showed some improvement. In five out of eight studies, the patients received access to telemedicine.

The HbA1C levels in these patients showed a mean increase of 0.14%. Moreover, in one study comparing diabetics and non-diabetics, both showed a significant increase of 0.7% and 0.02%, respectively.

Only four studies reported changes in BMI, with three studies showing a gain of 0.3 kg to 0.8 kg, while one reported an improvement in BMI values.

Implications

The current study demonstrates that patients with T1DM showed an improvement in their glycemic control during the COVID-19 lockdown, with both HbA1C and TIR showing a significant difference. The opposite direction of change was seen in T2DM patients.

The reason for these differences may lie in the contrast in the disease processes underlying the two conditions. For T1DM, the autoimmune pathology demands insulin therapy; thus, the availability of digital management during the lockdown may have helped improve their access to adequate treatment.

Conversely, the need for a sensible diet and exercise in the management of both types of DM demonstrates that other factors must be sought to explain this beneficial change.

Many T1DM patients are children; therefore, the lockdown could have freed parents to look after them, while also providing young adult patients the time for self-care and other measures that are favorable to diabetes management such as a better family diet, more exercise, psychosocial factors, and perhaps more attention for one’s health needs.

A more ordered routine, especially with respect to meal timing, may also have helped improve the health status T1DM patients. Finally, the use of multiple digital treatments for T1DM could have also assisted them in achieving good glycemic control.

Comparatively, T2DM patients may have slipped into unhealthy diets, with cravings for sweets and snacks, along with an increased tendency to a sedentary lifestyle during the pandemic. The lack of sleep, financial stress, anxiety, and lack of access to hospitals and pharmacies, may have accentuated the difficulty of these patients with their glycemic control.

Many of the papers reviewed here were from Europe and Spain, which had a very strict lockdown. The findings may therefore vary between countries.

“To our knowledge, this review presents the first overview of the impact of the COVID-19 lockdown on glycemic values of T1D and T2D patients.”

Further analysis of other outcomes is necessary, such as the changes in lifestyle, availability of health resources, and the association with a patient location as well as the temporal trends.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.