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. 2021 Mar:173:108682.
doi: 10.1016/j.diabres.2021.108682. Epub 2021 Feb 2.

The impact of a prolonged lockdown and use of telemedicine on glycemic control in people with type 1 diabetes during the COVID-19 outbreak in Saudi Arabia

Sahar K Alharthi  1 , Ebtihal Y Alyusuf  2 , Abdullah M Alguwaihes  2 , Assim Alfadda  3 , Mohammed E Al-Sofiani  4
Affiliations

The impact of a prolonged lockdown and use of telemedicine on glycemic control in people with type 1 diabetes during the COVID-19 outbreak in Saudi Arabia

Sahar K Alharthi et al. Diabetes Res Clin Pract. 2021 Mar.

Abstract

Background: To minimize the spread of Coronavirus Disease-2019, Saudi Arabia imposed a nationwide lockdown for over 6 weeks. We examined the impact of lockdown on glycemic control in individuals with type 1 diabetes (T1D) using continuous glucose monitoring (CGM); and assessed whether changes in glycemic control differ between those who attended a telemedicine visit during lockdown versus those who did not.

Materials and methods: Flash CGM data from 101 individuals with T1D were retrospectively evaluated. Participants were categorized into two groups: Attended a telemedicine visit during lockdown (n = 61) or did not attend (n = 40). Changes in CGM metrics from the last 2 weeks pre-lockdown period (Feb 25 - March 9, 2020) to the last 2 weeks of complete lockdown period (April 7-20, 2020) were examined in the two groups.

Results: Those who attended a telemedicine visit during the lockdown period had a significant improvement in the following CGM metrics by the end of lockdown: Average glucose (from 180 to 159 mg/dl, p < 0.01), glycemic management indicator (from 7.7 to 7.2%, p = 0.03), time in range (from 46 to 55%, p < 0.01), and time above range (from 48 to 35%, p < 0.01) without significant changes in time below range, number of daily scans or hypoglycemic events, and other indices. In contrast, there were no significant changes in any of the CGM metrics during lockdown in those who did not attend telemedicine.

Conclusions: A six-week lockdown did not worsen, nor improve, glycemic control in individuals with T1D who did not attend a telemedicine visit. Whereas those who attended a telemedicine visit had a significant improvement in glycemic metrics; supporting the clinical effectiveness of telemedicine in diabetes care.

Keywords: COVID-19; Continuous Glucose Monitoring; Lockdown; Telemedicine; Type 1 Diabetes.

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Figures

Fig. 1
Fig. 1
A Nationwide closure of schools and non-essential businesses was ordered on March 10, 2020; followed by a partial lockdown starting on March 24, 2020 that was upgraded to a complete lockdown from April 7 to April 23, 2020. Diabetes Telemedicine Clinic was implemented on March 10, 2020..
Fig. 2
Fig. 2
Changes in glycemic indices from pre-lockdown to end of lockdown in those who attended a telemedicine visit versus those who did not. A) Changes in Time In Range (TIR); B) Changes in Time Above Range (TAR); C) Changes in Glycemic Management Indicator (GMI). Abbreviations: TIR, time in range; TAR, time above range; GMI, glucose management indicator. * P < 0.05 comparing glycemic indices at the end-of-lockdown period to the pre-lockdown period.
See this image and copyright information in PMC

References

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