COVID-19 Lockdown Had Significant, Yet Varying, Impact on Glycemic Control

The impact of COVID-19-induced lockdown on glycemic values of patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) varied significantly between the populations, according to research presented at the 57th European Association for the Study of Diabetes annual meeting, held virtually from September 28 to October 1, 2021.

"To our knowledge, this review presents the first overview of the impact of the COVID-19 lockdown on glycemic values of T1D and T2D patients. Glycemic parameters in patients with T1D significantly improved during COVID-19 lockdown. In contrast, lockdown determined a short-term worsening in glycemic values in patients with T2D,” wrote coauthors Claudia Eberle, MD, and Stefanie Stichling, MSc, from the University of Applied Sciences, Germany, in the journal Diabetology & Metabolic Syndrome.

Eberle and colleagues note that the pandemic lockdown affected all aspects of daily life including routine healthcare activities. They were interested specifically in how that impact would manifest in glucose control among patients with diabetes.

For their systematic review, Eberle and Stichling searched databases including Cochrane Library and MEDLINE for studies published until April 2021 that reported the impact of COVID-19 lockdowns on glycemic control in patients with either T1D or T2D. A total of 33 observational studies published in either German or English were included in the analysis.

Also, researchers analyzed the impact of lockdown on outcomes compared to the time before lockdown and performed a meta-analysis on the most common parameters, which were A1c levels, time in range (TIR), and body mass index (BMI)/weight.

Patients with T1D fared better

The researchers found that in 25 studies including 2881 patients with T1D, 18 studies (72%) showed significant improvements in glycemic control, 4 (16%) showed no changes, and 3 (12%) reported a deterioration.

Compared to before lockdown, A1c levels decreased significantly in 11 out of 25 studies by an average of 0.05% (95% CI, -0.31-0.21). In 18 eligible studies, TIR significantly improved by an average of 3.75% (95% CI, 2.56-4.92), according to the study.

“Lockdown measures may have given people with type 1 diabetes more time to look after themselves, allowing them to eat more healthily and keep a close eye on their blood sugar levels. A more ordered routine, especially with respect to meal timing, may also have had health benefits,” explained Dr Eberle in a press release.

In contrast, researchers found that of the 8 studies including 1823 patients with T2D, 50% (n=4) showed clear deteriorations in glycemic control, while 25% (n=2) showed no changes. Meta-analysis demonstrated that A1c levels increased by an average of 0.14% (95% CI, -0.13-0.40) through the lockdown.

Furthermore, 75% (n=3) of the T2D studies reported a deterioration in weight between 0.3 kg and 0.95 kg, according to the study.

“During lockdown, people with type 2 diabetes may have developed unhealthy habits, such as eating more snacks, more screen time, and less physical activity. At the same time, lack of sleep, increased stress, anxiety, and restricted access to hospitals and pharmacies, may have heightened the difficulty of achieving good blood sugar control,” said Dr Eberle in the press release. “Larger studies in different locations will be needed to identify the actual impact of lockdown in people with diabetes on a broader scale.”

Study limitations included the exclusion of non-English and non-German-language studies and that the results demonstrated observational associations instead of cause and effect. The authors also noted that several of the papers were based on patients from Europe, particularly Italy and Spain, where lockdowns tended to be very strict, so the findings may not be generalizable to all countries.

Reference: Eberle C, Stichling S. Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review. Diabetol Metab Syndr. 2021;13:95.