Endocrine Abstracts

Introduction

Metabolic compensation of patients with diabetes mellitus (DM) depends on psychosocial well-being and healthy lifestyle, both of which were influenced by the national lockdown in spring 2020 due to the SARS-CoV-2 pandemic. The goal of our study was to analyze the impact of Swiss national lockdown (17.3.2020–24.4.2020) on compensation of DM as expressed by the level of HbA1c.

Methods

We performed a retrospective observational study using electronic health records of the University Hospital Basel. Patients with DM with at least one HbA1c measurement before and one after the begin of the lockdown were included. The observation period was 16.12.2018–27.07.2020. Time periods three months before (winter) and four months after the begin of the lockdown (spring) were defined and compared to corresponding time periods one year before. Patient determinants affecting HbA1c values were identified using a mixed-model regression multivariable analysis.

Results

We included 1078 patients in our analyses (925 type 2 DM, 145 type 1 DM, 8 other). Metabolic compensation was susceptible to seasonal changes with HbA1c highest in January with mean (standard deviation, S.D.) 7.60% (1.68), and lowest in July with mean (S.D.) 7.29% (1.67). In patients with type 2 DM, HbA1c decreased more in spring 2020 as compared to 2019 (difference of means 2020 = -0.22%, 95% confidence interval (CI): -0.058, -0.39, P = 0.008; vs. difference of means 2019 = -0.15%, 95% CI: -0.33, 0.03, P = 0.1), respectively. The differences in type 1 DM were not significant. Subgroup analysis of 241 patients with HbA1c in all analyzed periods yielded no significant change in HbA1c after the lockdown. Inappropriate alcohol intake was identified as a risk factor for increased HbA1c after lockdown (OR 1.69, 95% CI: 1.03, 2.75). Number of hospitalizations per patient decreased significantly after the lockdown (winter 2019/2020 mean (S.D.) 1.42 (0.83) vs. spring 2020, 1.24 (0.55) P = 0.028). The lockdown led to no significant change in weight (mean difference = 1.72 kg, 95% CI: -5.07, 1.63, P = 0.314).

Conclusion

Metabolic compensation of patients with DM undergoes marked seasonal variations, with highest HbA1c in winter and lowest in summer. Contrary to expectations, HbA1c in patients with type 2 DM did not increase in four months after the begin of national lockdown but decreased to the same values as the year before.