Endocrine Abstracts

Background and Aims: The COVID-19 pandemic severely affected the glycemic regulation of adult patients with type 1 diabetes (T1D). The aim of this study was to evaluate the impact of this pandemic on glycemic control in T1D patients with continuous subcutaneous insulin infusion (CSII) systems.

Methods: A cohort of adult T1D patients with CSII was retrospectively evaluated. Data regarding number visits to our diabetes clinics, total daily insulin dose (TDID), blood and estimated HbA1c (b- and eHbA1c), time in range (TIR) (70–180 mg/dl), time below range (TBR) (<70 mg/dl) time above range (TAR)(>180 mg/dl) and coefficient of variation (%CV) in the pre- (March 2018- March 2020) and the pandemic (April 2020- April 2022) were collected.

Results: 66 patients were studied (32 females) with mean age 44±12.1 years, mean body mass index [BMI] of 25.1±4 kg/m2 and mean total daily insulin dose (TDID) was 37±4.3 IU. Patients had a moderate glycemic control (mean bHbA1c 7.3±0.9%) while the mean estimated HbA1c (7.15±0.9%) (glucose management indicator or GMI) was slightly lower. Mean sensor use of patients was satisfactory (92.5%) while %CV (34.1±5.5%), which reflects intraday glycemic variability (GV), was marginally higher than normal. The average number of visits in the prepandemic period was 8, with a relatively strong negative correlation between this number of visits and HbA1c (r=-0.65) During the pandemic period, both BMI (25.1±4 vs 24.4±3.3 kg/m2, P=0.11) and TDID (37±4.3 vs 36.1±3.6 IU, P=0.33) remained stable. On the contrary, TIR increased significantly (65.8±8.6 vs 70.2±16.8%; P=0.026) while TBR (5.8±4 vs 4.9±3.8%; P=0.007) and TAR (28.4±5.4 vs 24.9±3.3%; P=0.03) diminished substantially. Furthermore, mean bHbA1c (7.3±0.9 vs 7.15±0.7%; P=0.01), eHbA1c (7.15±0.9 vs 6.94±0.65%; P=0.005) and %CV (34.1±5.5 vs 31.7±4.1%; P<0.001) decreased considerably during the pandemic. Additionally, the average number of visits was reduced to 4 per person in the postpandemic period and this number was moderately and negatively correlated with glycemic control (r=-0.45).

Conclusions: Glycemic regulation of adult patients with T1D and CSII improved significantly during the pandemic, despite reduced visits to the diabetes outpatient clinics.