Associations between the COVID-19 pandemic and glycemic control in pediatric type 1 and type 2 diabetes

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ESPR231
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Abstract: :


Background: Beginning in March 2020, lockdowns and school closures due to the COVID-19 pandemic disrupted the daily routines of children and their caregivers. Due to the increased presence of children at home but ongoing demands on working parents, this disruption could have led to either increased or decreased supervision of pediatric patients with type 1 and type 2 diabetes (T1D, T2D), which may have impacted glycemic control due to altered chronic disease management.

Objective: To investigate trends and predictors of glycemic control, as measured by HbA1c, before and during the coronavirus pandemic among youth with T1D and T2D.

Methods: Retrospective cohort study of youth (<22 years) with T1D or T2D who had HbA1c measured pre-pandemic (January-February 2020) and 6 months later (July-August 2020, 4 months into the pandemic).  Student's paired t-test was used to evaluate change in HbA1c, and univariable and multivariable linear regression were used to evaluate predictors of change in HbA1c, including age, sex, race, pubertal status, diabetes type, baseline glycemic control, technology use (insulin pump, continuous glucose monitor [CGM]), use of telemedicine, insurance type (Medicaid versus commercial), and occurrence of diabetic ketoacidosis or ketosis (DKA/DK) between HbA1c measurements.

Results: The cohort included 335 (n=189, 56% male; n = 13, 4% T2D) patients, with mean (SD) age 14.2 (3.5) years. One-fifth were pre-pubertal, and 15% had Medicaid as their primary insurance. The majority were white (71%), followed by Black (12%) and mixed/"other" race (14%). Eighty percent used a CGM at both timepoints, while 4% began use. Nine patients had DKA/DK. Over 90% of the 230 patients who attended a visit between timepoints did so via telemedicine. Mean HbA1c decreased from 8.2% (SD 1.8) to 8.0% (SD 1.7) (mean difference -0.2%, 95% CI -0.1 to -0.3%, p = 0.0001). In multivariable regression, T2D was associated with a positive change in HbA1c relative to T1D (beta = 0.61, 95% CI 0.04-1.18, p = 0.04), while poor baseline glycemic control (HbA1c≥8%) was associated with a greater decrease in HbA1c (beta = -0.4, 95% CI -0.65- -0.21, p<0.001). Among patients with T1D, poor baseline control (beta = -0.4, 95% CI -0.6- -0.1, p = 0.002), starting a CGM (versus continued use, beta = -1.0, 95% CI -1.6- -0.5, p <0.001), and interim DKA/DK (beta = -0.9, 95% CI -1.6- -0.3, p = 0.005) were associated with greater decrease in HbA1c. Age, sex, race, pubertal status, use of telemedicine, and insurance type were not significant predictors of change in HbA1c.

Conclusions: Among pediatric patients with diabetes, glycemic control improved slightly in the beginning of the COVID-19 pandemic. Poor baseline glycemic control was associated with a greater reduction, possibly due to greater room for improvement. The persistence of these changes and the impact of pandemic-associated stressors on the individual patient- and caregiver-level should be the focus of future studies.

Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia

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