Youth with Type 1 Diabetes had Improvement in Continuous Glucose Monitoring Metrics During the COVID-19 Pandemic.

Abdulhussein, Fatema; Chesser, Hannah; Boscardin, W John; Wong, Jenise C; Gitelman, Stephen

BACKGROUND The impact of the COVID-19 pandemic on glycemic metrics in children is uncertain. This study evaluates the effect of the shelter-in-place (SIP) mandate on glycemic metrics in youth with type 1 diabetes (T1D) using continuous glucose monitoring (CGM) in Northern California, United States. METHODS CGM and insulin pump metrics in youth 3-21 years old with T1D at an academic pediatric diabetes center were analyzed retrospectively. Data 2-4 months before (distant pre-SIP), 1 month before (immediate pre-SIP), 1 month after (immediate post-SIP), and 2-4 months after (distant post-SIP) the SIP mandate were compared using paired t-tests, linear regression, and longitudinal analysis using a mixed effects model. RESULTS Participants (n=85) had reduced mean glucose (-10.3 ± 4.4 mg/dl, p = 0.009), standard deviation (SD) (-5.0 ± 1.3 mg/dl, p=0.003), glucose management indicator (GMI) (-0.2 ± 0.03%, p=0.004) and time above range (TAR) > 250 mg/dl (-3.5 ± 1.7%, p = 0.01), and increased time in range (TIR) (+4.7 ± 1.7%, p = 0.0025) between the distant pre-SIP and distant post-SIP periods. Relationships were maintained using a mixed effects model, when controlling for other demographic variables. There was improvement in SD, TAR 180-250 mg/dl, and TIR for participants with private insurance, but changes in the opposite direction for participants with public insurance. CONCLUSIONS Improvement in CGM metrics in youth with T1D during the COVID-19 pandemic suggests that diabetes management can be maintained in the face of sudden changes to daily living. Youth with public insurance deserve more attention in research and clinical practice.