Blood sugar control improved during COVID-19 lockdown among type 1 diabetes patients

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Among people with type 1 diabetes who stopped working in the COVID-19 lockdown, blood sugar levels improved during the first week of lockdown despite having reduced opportunities for exercise and heightened psychological stress, according to new research published in the journal Diabetes Therapy.

For the study, researchers used data from 33 individuals with type 1 diabetes who attended the diabetes outpatient clinic of the University Hospital of Padova, lived in the area, used a flash glucose monitoring system to monitor their glucose levels for at least three  months, were sharing sensor data with the clinic, and had returned more than 90 percent of readings.

The time periods upon which the study was based included the three months before the start of measures to control the outbreak, the week immediately prior to the introduction of controls, the 14 days between the start of restrictions and full lockdown, and the first week of lockdown when everyone apart from essential workers was requested to stay at home.

Patients were divided into two groups based on whether they stopped working during lockdown or continued to work due to being classed as an essential worker, with the latter serving as the control group. The 20 who stopped working had an average age of 37 years, 60 percent were male, and had been living with diabetes for 15 years on average. The 13 who continued to work had an average age of 45 years, 53.8 percent were male, and their average diabetes duration was five years. Eight members of this second group were on insulin pump therapy which continuously supplies insulin and largely replaces the need for the patient to inject themselves multiple times per day, according to the study.

Average blood glucose concentration decreased in these individuals from 177mg/dL in the week before lockdown to 160mg/dL during lockdown itself; the proportion of time spent within the safe range increased from 54.4 percent to 65.2 percent, and time spent in hyperglycemia decreased from 42.3 percent to 31.6 percent, while there was no significant change in time spent in hypoglycemia. In contrast, the 13 patients who continued working during lockdown exhibited no improvement or deterioration in any of the measures of glycemic control compared with before lockdown, the study said.

The researchers speculate that the improvement in patients who stopped working occurred due to them having more time to focus on diabetes control and a more regular lifestyle, including the timing and composition of meals. Additionally, the researchers said the knowledge that diabetes worsens the COVID-19 outcomes may have improved patients' awareness and compliance to diabetes management.

Participants had relatively good blood sugar control to begin with, so it is unclear whether the same results would apply to patients with worse glucose control or less frequent sensor scans, the authors said. Lastly, only one week of lockdown was studied due to subsequent weeks introducing potential bias from patients having been contacted by the clinic with advice on diabetes management. Despite this, the data collected after this first week of lockdown suggests that this better blood sugar control continued in the patients who stopped working. Furthermore, other research from Spain backs the findings of the study.

"Despite the psychological stress and very limited opportunities for exercise, the study found that glucose control was significantly improved in patients with [type 1 diabetes] who stayed at home during the first week of the COVID-19-induced lockdown in Italy,” the authors write in the study. “This observation suggests that slowing down routine activities can have beneficial effects on [type 1 diabetes] control in the short term. However, the long-term effects of lockdown and the factors that affect glucose control in this particular situation deserve future investigation."

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