Effects of work status changes and perceived stress on glycaemic control in individuals with type 1 diabetes during COVID-19 lockdown in Italy

Barchetta, Ilaria; Agata Cimini, Flavia; Bertoccini, Laura; Ceccarelli, Valentina; Spaccarotella, Michele; Giorgio Baroni, Marco; Gisella Cavallo, Maria

Aims To evaluate the effects of COVID-19 lockdown on blood glucose control in individuals with type 1 diabetes (T1D) and to explore determinants of glucose variability. Methods Fifty T1D patients undergoing continuous/flash glucose monitoring were recruited. The study’s primary outcome was the change of time in range (TIR) from before to lockdown period. Three time-point comparisons of TIR, mean glucose levels (MG), estimated (e)HbA1c, time above (TAR) and below range (TBR), moderate/severe hypoglycemic events between pre-lockdown, lockdown and post-lockdown period were also performed. Information on lockdown-associated perceived stress, changes of work status and physical activity were recorded. Results TIR significantly decreased (75(63-84)% vs. 69(50-76)%, p<0.001) whereas MG (154±15 mg/dl vs. 165±25 mg/dl, p=0.027) and eHbA1c (7.3(6.6-7.8)% vs. 7.5(6.7-8.2)%, p=0.031) increased from pre- to lockdown period; overall glucose control significantly improved when restriction ended. Lockdown-associated work loss/suspension independently predicted impaired TIR after adjustment for potential confounders (Standardized β:-0.29; 95%CΙ:-18.7–-2.25; p=0.01). Greater TAR, TBR and hypoglycemic events were also reported during the lockdown. Conclusion In T1D Italian individuals, blood glucose control significantly worsened during the COVID-19 lockdown; work instability and related issues represented the main determinant of impaired glucose variability in this population.