Behavioral changes during the COVID-19 pandemic can improve blood glucose control, providing an unexpected “bright side” to diabetes patients.
About a year ago, the whole world faced the start of the COVID-19 pandemic. Many countries instituted lockdowns while others created some precautionary measures to continue with what we consider now “the normality.” At the beginning of the pandemic, patients with pre-existing conditions such as diabetes, asthma, etc., were considered more vulnerable to get the COVID-19 virus. Especially in patients with diabetes, the concern was about potential increases in their sedentary behavior. It was essential to create ways to treat them while their blood sugar was out of control and they were at home. Their psychological burden was on the rise since the virus was something new worldwide, and physicians’ appointments were limited. Anxiety and emotional stress also affect their glycemic control. However, a bright side of the pandemic also manifested. Now, these patients are at home, with altered daily routines; some have experienced a decrease in workloads. This scenario seems to be an excellent opportunity to take a moment and start doing small behavioral changes that, in the long run, will help these patients to overcome some challenges experienced with the management of diabetes.
An observational study conducted in Paris includes 1,378 patients from 35 to 56 years old with type 1 diabetes who used the Flash Glucose Monitoring (FGM) device. From April 23, 2020, which was the beginning of the lockdown, they collected behavioral information, lifestyle modifications, and current treatment to compare it with data collected 38 days later. The researchers primarily looked at differences in glycemic control in these patients by looking at the mean glucose from the last 30 days reported in the FGM. Statistical analysis used includes X2 test and student t-test.
The data collection was via a website called CoviDIAB, where the participants were reporting all data. They observed an improvement in the glycemic control from 163.5 to 155.7 (p<0.001) on average during the lockdown. They noticed that younger adults participating in the study with higher HbA1C had an improvement after reducing food intake and snacking during the lockdown. During the pandemic, it was a trend for people to start exercising, and some participants reported weight loss of 1-3kg. Also, the study monitored the number of hypoglycemic events. Results showed a decrease in hypoglycemic events in 309 participants. Hypoglycemic events’ frequency was stable in 713 participants for an OR: 1.67 [1.13-2.46] with a p<0.001. Bars were closed, and the decrease in alcohol intake also helped them improve their glycemic control. These changes performed by the participants allowed them to adjust their insulin by decreasing their intake.
In another similar study published in Italy during 2020, they looked at the effect of lockdown on ambulatory glucose metrics. In this study, they used a smaller sample size, and they monitored the data for 14 days. In this study, glucose metrics did not change significantly, but they observed a decrease in hypoglycemic events.
Some weaknesses found in the study conducted in Paris are the exclusion of patients who do not carry an FGM, making it a study with a small number of participants. Due to the small sample size, this study cannot be generalized to the whole population. Another weakness was that patients were self-reporting their data on a website, which can result in some bias.
This study can help us guide our patients in the importance of lifestyle modifications and how these changes can improve their health. It is vital to our diabetic population to control what they eat, when they eat, how much they eat, and to know how to monitor their blood glucose before and after eating. In this study, eating patterns, physical activity, and constant blood glucose monitoring were crucial in improving patients’ health.
- Lifestyle modifications and behavioral changes, including exercise, can improve glycemic control.
- Maintaining glucose control can reduce insulin intake.
- Tracking blood glucose before and 2 hours after meals can help patients with diabetes manage their condition more comfortably.
References for “The Bright Side Of Having Diabetes During COVID-19”:
Louis Potier, Boris Hansel: Stay-at-Home Orders During the COVID-19 Pandemic, an Opportunity to Improve Glucose Control Through Behavioral Changes in Type 1 Diabetes, Diabetes Care Dec 2020,
Ernesto Maddaloni, Lucia Coraggio: Effects of COVID-19 Lockdown on Glucose Control: Therapy, Diabetes Care Aug 2020,
Laura Martínez López, PharmD. Candidate 2021, Lake Erie College of Osteopathic Medicine, College of Pharmacy