HbA1c improves for kids during UK COVID lockdownFriday, 26 March 2021
Children in the UK with type 1 diabetes saw decreases in HbA1c and mean blood glucose levels after the country’s COVID-19 lockdown began compared with before, according to data reported in Endocrine Today.
“This is the first study published with this data in children and young people,” said Dr Neil Lawrence, a paediatric registrar at Sheffield Children’s Hospital NHS Foundation Trust, and NIHR academic clinical fellow at the University of Sheffield.
India’s shortage of test strips
“Studies in developed countries such as Scotland, Italy and Spain have shown a similar effect in adults. Findings in India were that glycaemic control was worse during lockdown, but there was a notable national shortage of glucose testing strips in India during this time.”
Children with type 1 diabetes in the UK had a decrease in mean HbA1c during the country’s first COVID-19 lockdown from 8.3% to 7.8%.
Dr Lawrence and colleagues analysed data from glucose monitoring devices used by children with type 1 diabetes who were patients at Doncaster and Bassetlaw Teaching Hospitals.
All children had type 1 diabetes for at least one year. Data from a 12-week period from Dec 30, 2019, to March 22, 2020, were used for the pre-lockdown period. The post-lockdown data were collected from March 30 to June 21, 2020.
HbA1c and mean glucose levels both decreased
HbA1c and mean glucose level were the primary outcomes in the study. Standard deviation and proportion of time spent in range were secondary outcomes.
There were 80 children included in the study (median age, 13.6 years), of whom 23 used a continuous glucose monitor, 24 used a flash glucose system and 33 performed self-monitoring blood glucose.
From 8.3% to 7.8%
The study cohort had a decrease in HbA1c from 67.4 mmol/mol (8.3%) during the pre-lockdown period to 61.3 mmol/mol (7.8%) after the lockdown (P < .001).
Mean blood glucose level also decreased for participants, from 9.7 mmol/L before the lockdown to 9.5 mmol/L after the lockdown (P = .044). The mean standard deviation of blood glucose decreased from 4.4 mmol/L before the lockdown to 4.1 mmol/L post-lockdown (P < .001). Participants also increased their time in range from before the lockdown to after (55.2% vs. 58%; P = .017).
Phone and video calls increased patient contact
The improvement in glycaemic control was observed even with a decrease of in-person visits to clinics. The number of phone and video contacts with patients in the study cohort increased from 1,751 before the lockdown to 2,269 after the lockdown. The number of face-to-face patient contacts decreased from 245 before the lockdown to 151 after the lockdown.
“People were worried that an increase in remote consultations by video and phone and a reduction of face-to-face appointments would make glycaemic control worse,” Dr Lawrence said.
More flexibility for future appointments
“There was no evidence of this. Future practice should reflect more flexibility around how patients and families attend their appointments.”
Dr Lawrence said the findings are a testament to the difficulties children with type 1 diabetes face when not at home. Health professionals should focus on improving diabetes management outside of the home.
Training needed for outside the home
“This shows the importance of dealing with behaviour when managing type 1 diabetes,” Dr Lawrence said. “Education of patients and families should be based around this.”
An analysis of data from the UK’s second lockdown is underway. The data should clarify whether these findings were due more to the pandemic or the closing of schools.
(Data were derived from Lawrence N, et al. Impact of COVID-19 national lockdown on glycemic control in children and adolescents with type 1 diabetes (T1DM): A retrospective review at a large UK teaching hospital. Presented at: Endocrine Society Annual Meeting; March 20-23, 2021, virtual meeting).