Improvement in glycaemic control in paediatric and young adult type 1 diabetes patients during COVID-19 pandemic: role of telemedicine and lifestyle changes.

Main Article Content

Pietro Lazzeroni
Matteo Motta
Sara Monaco
Serena Rosa Laudisio
Daria Furoncoli
Valentina Maffini
Monica Rubini
Bertrand Tchana
Claudio Ruberto
Icilio Dodi
Brunella Iovane


Type 1 diabetes, HbA1c, Telemedicine, COVID-19


Background and aim: COVID-19 pandemic determined a profound impact in everyday life and in routine follow-up of patients with type 1 diabetes (T1D). In this context, telemedicine represented an important tool to guarantee a regular care for these patients. Aim of our work was to assess metabolic control before and after lockdown in the cohort of T1D patients followed-up by our Service, to evaluate the impact of restrictive measures and of disease management through telemedicine.

Methods: This is a retrospective observational study. Subjects were enrolled among children, adolescents and young adults affected by T1D and followed at the Regional Paediatric Diabetology Centre of the University-Hospital of Parma, Italy. We collected data about age, gender, ethnicity, anthropometric measurements, duration of disease, type of blood glucose monitoring used, type of insulin administration, daily insulin requirement and metabolic control, assessed using capillary HbA1c.

Results: We enrolled 139 patients, mean age 13.9 years. During lockdown, we reported significantly more contacts through telemedicine between patients and medical team. Global glycol-metabolic control significantly improved, without differences in daily insulin requirement. Patients with a previous poor-controlled diabetes showed a greater improvement. Finally, mean weekly hours of physical activity decreased significantly, without worsening in BMI z-score.

Conclusions: Our results show a global improvement in mean HbA1c, with a stronger result for patients with a previous non satisfactory control. In our setting, despite regulatory rules and physical and logistic limitations related to pandemic, no worsening of metabolic control has been shown for patients with type 1 diabetes.


Download data is not yet available.
Abstract 754 | PDF Downloads 538


3. 20A01605/sg
4. Keesara S, Jonas A, Schulman K. Covid-19 and Health Care’s Digital Revolution. N Engl J med 2020; 382: e82.
5. Giani E, Laffel L. Opportunities and Challenges of Telemedicine: Observations from the Wild West in Pediatric Type 1 Diabetes. Diabetes Technol Ther 2016; 18: 1-3.
6. Beck RW, Bergenstal RM, Laffel LM, Pickup JC. Advances in technology for management of type 1 diabetes. Lancet 2019; 394: 1265–1273.
7. Vanelli M. “Hello, diabetes.” Preventing DKA in children with a telephone hotline service. DiabetesVoice 2008; 53: 22-24.
8. Clary L, Wang C, Byrne ME, Monaghan M. COVID-19 Pandemic-Related Practices and Policies Affecting the Continuity of Behavioral Health Care Among Children With Diabetes. Transl Behav Med 2020; 10: 819–826.
9. Elbarbary NS, Dos Santos TJ, de Beaufort C, Agwu JC, Calliari LE, Scaramuzza AE. COVID-19 outbreak and pediatric diabetes: Perceptions of health care professionals worldwide. Pediatr Diabetes 2020; 21: 1083-1092.
10. Pelizzola D. Diabetes assistance before, during and after Covid-19 in Ferrara, Italy. Int Journ Care Coord 2020; 23: 61–64.
11. Aragona M, Rodia C, Bertolotto A, Campi F, Coppelli A, Giannarelli R, et al. Type 1 diabetes and COVID-19: The “lockdown effect.” Diabetes Res Clin Pract 2020; 170: 108468.
12. Bonora BM, Boscari F, Avogaro A, Bruttomesso D, Fadini GP. Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy. Diabetes Ther 2020; 11: 1-11.
13. Capaldo B, Annuzzi G, Creanza A, Giglio C, De Angelis R, Lupoli R, et al. Blood Glucose Control During Lockdown for COVID-19: CGM Metrics in Italian Adults With Type 1 Diabetes. Diabetes Care 2020; 43: e88-e89.
14. Di Dalmazi G, Maltoni G, Bongiorno C, Tucci L, Di Natale V, Moscatiello S, et al. Comparison of the effects of lockdown due to COVID-19 on glucose patterns among children, adolescents, and adults with type 1 diabetes; CGM study. BMJ Open Diabetes Res Care 2020; 8: e001664.
15. Dover AR, Ritchie SA, McKnight JA, Strachan MWJ, Zammitt NN, Wake DJ, et al. Assessment of the effect of the COVID-19 lockdown on glycaemic control in people with type 1 diabetes using flash glucose monitoring. Diabet Med 2021; 38: e14374.
16. Xiumei W, Sihui L, Xueying Z, Yu D, Siqi W, Ping L, et al. Glycemic control in type 1 diabetes children and teenagers around lockdown for COVID-19: a continuous glucose monitoring based observational study. J Diabetes Investig 2021. doi: 10.1111/jdi.13519.
17. Barmpagianni A, Lambadiari V, Papazafiropoulou A, Kountouri A, Stergiou A, Melidonis A, et al. Glycemic Control of Patients with Type 1 Diabetes Using an Insulin Pump Before and During the COVID-19-Associated Quarantine. Diabetes Technol Ther 2020. doi: 10.1089/dia.2020.0423.
18. Longo M, Caruso P, Petrizzo M, Castaldo F, Sarnataro A, Gicchino M, et al. Glycemic control in people with type 1 diabetes using a hybrid closed loop system and followed by telemedicine during the COVID-19 pandemic in Italy. Diabetes Res Clin Pract 2020; 169:108440.
19. Moreno-Domínguez Ó, González-Pérez de Villar N, Barquiel B, Hillman-Gadea N, Gaspar-Lafuente R, Arévalo-Gómez M, et al. Factors Related to Improvement of Glycemic Control Among Adults with Type 1 Diabetes During Lockdown Due to COVID-19. Diabetes Technol Ther 2020. doi: 10.1089/dia.2020.0550.
20. Fernández E, Cortazar A, Bellido V. Impact of COVID-19 lockdown on glycemic control in patients with type 1 diabetes. Diabetes Res Clin Pract 2020; 166: 108348.
21. Potier L, Hansel B, Larger E, Gautier JF, Carreira D, Assemien R, et al. Stay-at-Home Orders During the COVID-19 Pandemic, an Opportunity to Improve Glucose Control Through Behavioral Changes in Type 1 Diabetes. Diabetes Care 2021; 44: 839-843.
22. Ceconi V, Barbi E, Tornese G. Glycemic control in type 1 diabetes mellitus and COVID-19 lockdown: What comes after a "quarantine"? J Diabetes 2020; 12: 946-948.
23. Rachmiel M, Lebenthal Y, Mazor-Aronovitch K, Brener A, Levek N, Levran N, et al. Glycaemic control in the paediatric and young adult population with type 1 diabetes following a single telehealth visit - what have we learned from the COVID-19 lockdown? Acta Diabetol 2021; 1: 1-9.
24. Ruissen MM, Regeer H, Landstra CP, Schroijen M, Jazet I, Nijhoff MF, et al. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic. BMJ Open Diabetes Res Care 2021; 9: e002035.
25. Schiaffini R, Barbetti F, Rapini N, Inzaghi E, Deodati A, Patera IP, et al. School and pre-school children with type 1 diabetes during Covid-19 quarantine: The synergic effect of parental care and technology. Diabetes Res Clin Pract 2020; 166: 108302.
26. Tornese G, Ceconi V, Monasta L, Carletti C, Faleschini E, Barbi E. Glycemic Control in Type 1 Diabetes Mellitus During COVID-19 Quarantine and the Role of In-Home Physical Activity. Diabetes Technol Ther 2020; 22: 462–467.
27. Predieri B, Leo F, Candia F, Lucaccioni L, Madeo SF, Pugliese M, et al. Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic. Front Endocrinol 2020; 11: 595735.
28. Shah N, Karguppikar M, Bhor S, Ladkat D, Khadilkar V, Khadilkar A. Impact of lockdown for COVID-19 pandemic in Indian children and youth with type 1 diabetes from different socio-economic classes. J Pediatr Endocrinol Metab 2020; 34: 217-223.
29. Marigliano M, Maffeis C. Glycemic control of children and adolescents with type 1 diabetes improved after COVID-19 lockdown in Italy. Acta Diabetol 2021; 2: 1-4.
30. Tinti D, Savastio S, Grosso C, De Donno V, Trada M, Nugnes M, et al. Impact of lockdown during COVID-19 emergency on glucose metrics of children and adolescents with type 1 diabetes in Piedmont, Italy. Acta Diabetol 2021; 58: 959-961
31. Barchetta I, Cimini FA, Bertoccini L, Ceccarelli V, Spaccarotella M, Baroni MG, et al. Effects of work status changes and perceived stress on glycaemic control in individuals with type 1 diabetes during COVID-19 lockdown in Italy. Diabetes Res Clin Pract 2020; 170: 108513.
32. Verma A, Rajput R, Verma S, Balania VKB, Jangra B. Impact of lockdown in COVID 19 on glycemic control in patients with type 1 Diabetes Mellitus. Diabetes Metab Syndr 2020; 14: 1213-1216.
33. Al Agha AE, Alharbi RS, Almohammadi OA, Yousef SY, Sulimani AE, Alaama RA. Impact of COVID-19 lockdown on glycemic control in children and adolescents. Saudi Med J 2021; 42: 44-48.
34. Tao J, Gao L, Liu Q, Dong K, Huang J, Peng X, et al. Factors contributing to glycemic control in diabetes mellitus patients complying with home quarantine during the coronavirus disease 2019 (COVID-19) epidemic. Diabetes Res Clin Pract 2020; 170: 108514.
35. Fisher L, Polonsky W, Asuni A, Jolly Y, Hessler D. The early impact of the COVID-19 pandemic on adults with type 1 or type 2 diabetes: A national cohort study J Diabetes Complications 2020; 34: 107748.
36. Mayer-Davis EJ, Kahkoska AR, Jefferies C, Dabelea D, Balde N, Gong CX, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2018; 19: 7-19.
37. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, et al. CDC Growth Charts: United States. Adv Data 2020; 8: 1-27.

Most read articles by the same author(s)

1 2 > >>