With stay-at-home orders, daily routines for many diabetes patients have been disrupted, creating concerns over the possible consequences of added stress, isolation, and elevated blood sugars, and the impact of COVID-19 on glucose management.
The coronavirus disease 2019 (COVID-19) has forced many countries to enact lockdowns in efforts to stop contagion. Suddenly, patients are faced with new challenges of self-isolation, such as an increased sedentary lifestyle, stress, and changes in eating habits. These challenges are especially worrisome for patients living with diabetes, as disruption from a routine can have devastating effects on glucose control. Current evidence emphasizes the importance of glucose control in preventing complications stemming from uncontrolled diabetes. Added to these concerns is the limited access patients now have to outpatient services providing education on self-monitoring blood glucose, diet, and exercise. Such concerns are especially relevant for patients with complex regimens such as multiple daily injections (MDI) of insulin or continuous subcutaneous insulin infusions (CSII). Consequently, understanding the effects of quarantine on lifestyle and glucose control has become the focus of a new study in Italy.
Researchers aimed to investigate the effects of lockdown on glucose control using ambulatory glucose metrics, defined by an international consensus on time in range (TIR). As Italy began its lockdown on March 9, 2020, analysis of continuous glucose monitoring (CGM) data from two weeks preceding and two weeks following the lockdown was performed in patients with diabetes on MDI insulin or CSII regimens. Participants were excluded if they were unable to upload CGM data or if there were any therapeutic changes made during the study. A total of 55 participants were included in the study, with a median age of 41 years and an average disease duration of 11 years. Over 90% of the patients had type 1 diabetes, with the remainder having type 2. The study was designed with 90% power to detect a change in TIR of greater than 10% using a paired t-test and an alpha level of 0.05. Secondary endpoints included evaluating glycemic effects of quarantine on individuals with a higher risk of hypoglycemia or more inadequate glycemic control.
The study determined that the mean TIR for patients during lockdown was 57.1%, with a standard deviation of 16.7%. These TIR scores did not significantly differ from TIR scores taken weeks preceding quarantine. As a result, the study showed that no significant changes occurred in patients’ glucose profiles during the first 14 days of isolation. However, the study did find significant reductions in length of hypoglycemia and time below range (TBR), suggesting that participants improved glycemic control during the lockdown. The adverse effects predicted to accompany quarantine such as stress and sedentary lifestyle could have been counteracted by increased time for meal planning and decreased workloads. Most participants did not continue to work during quarantine, allowing them more time to manage the many diabetes challenges. These reasons could also explain the improvements in hypoglycemia and reduced time below range.
Patients with diabetes already face higher mortality rates and increased ICU stays following COVID-19 infection. For this reason, practicing social distancing and self-quarantine is advised whenever possible. However, the implications of such a drastic change in lifestyle have been hypothesized to affect glucose management. Evidence from the study shows that this may not be the case. Patients reported better glycemic control during isolation, likely due to fewer responsibilities and more free time. Even so, the generalizability of the findings is limited by the study’s small sample size and short duration. Future studies utilizing larger sample populations and more CGM data points could provide more significant insights into the lockdown effects on diabetes management.
- Lockdown following the COVID-19 pandemic has the potential to alter glucose management in patients with diabetes.
- Continued patient education on the importance of continuous glucose monitoring is essential in preventing complications of diabetes.
- The study found that there was no difference between time in range (TIR) for continuous glucose measurements taken before and after lockdown.
Maddaloni, Ernesto, et al. “Effects of COVID-19 Lockdown on Glucose Control: Continuous Glucose Monitoring Data From People With Diabetes on Intensive Insulin Therapy.” Diabetes Care, 2020, p. dc200954. doi:10.2337/dc20-0954.McQueen, R. Brett.
Wang, Aihong, et al. “Timely Blood Glucose Management for the Outbreak of 2019 Novel Coronavirus Disease (COVID-19) Is Urgently Needed.” Diabetes Research and Clinical Practice, vol. 162, 2020, p. 108118. doi:10.1016/j.diabres.2020.108118.
Stephen Rubano, PharmD. Candidate, USF Taneja College of Pharmacy