Metabolic control in pediatric T1D patients during COVID 19

Metabolic control in pediatric T1D patients during COVID 19 | Image Credit: © Monkey Business - © Monkey Business - stock.adobe.com.

The SARS-CoV2 pandemic was expected to have an impact on chronic disease control, but the extent of which might not even be fully realized for some time. Restrictions on social gatherings led to limited access in terms of medical visits, follow-up care and—in some cases—even medications and food.

While any chronic disease could be impacted by these challenges, type 1 diabetes (T1D) can be particularly susceptible to changes in routine, nutrition, and medication habits.

One study, published in Acta Diabetalogica, followed multiple waves of the pandemic in Germany, examining how daily life and access to healthcare services influenced T1D outcomes in pediatric patients.

Lockdowns occurred intermittently between 2020 and 2021, including school closures throughout Germany, according to the report. The research team investigated how these changes in routines and habits may have impacted diabetes care and found that glycemic control remained stable in the study group—which represented about 90% of pediatric T1D patients in Germany.

The median age of the group in the study was approximately 14 years, with typical diagnosis duration of about 5 years. About one-third of the study group had migratory living patterns, nearly 60% used an insulin pump, and about 75% used continuous glucose monitoring devices, according to the study.

Despite the challenges of the pandemic, the study team used HbA1c levels, continuous glucose readings, and other glucose measurements to deduce that overall metabolic control didn’t significantly change during the lockdown and other pandemic measures.

Even migrant groups were able to maintain good glycemic control, possibly due to an increase in the use of telehealth visits and work with remote care diabetes management teams. These measures may have increased health care access for some of these groups, according to the study, resulting in an overall maintenance of T1D control—and in some cases even a slight improvement.

What did spike during the pandemic, however, were body-mass index (BMI) levels for pediatric T1D patients, according to the report. While this increase in body mass was likely the result of increased screen time due to home schooling and social isolation measures, decreased physical activity, and changes in eating habits, it could still result in additional health risks for pediatric T1D patients, the study concludes.

Still, these BMI increases and the negative effects that could result appear to be balanced, at least in the short term, by the positive aspects of the lockdown on T1D patients. Increased parental supervision and time at home may have benefitted many patients, although the pandemic is also credited with increasing stress, social isolation, and anxiety beyond the normal in both caregivers and children with T1D.

Still, all of the changes recorded didn’t increase the prevalence of T1D complications like cases of diabetic ketoacidosis or hypoglycemic coma. Hypoglycemic episodes did increase overall towards the end of the study period, though, as lockdown measures increased, and patients became more active again.

The study highlights the need, should a similar pandemic or activity lockdown occur, for clinicians and diabetes support teams to encourage exercise and regular activity in addition to regular treatment strategies for children with T1D.

Reference:

Hammersen, J., Tittel, S.R., Khodaverdi, S. et al. Metabolic control during the first two years of the COVID-19 pandemic in pediatric patients with type 1 diabetes: results from the German DPV initiative. Acta Diabetol 60, 757–766 (2023). https://doi.org/10.1007/s00592-023-02050-x