Impact of lockdown on children with type-1 diabetes: returning to the community was associated with a decrease in HbA1c

Benjamin Morat; Nadine Lucidarme; Auriane Gibert; Carole Harbulot; Noémie Lachaume; Stéphanie Gréteau; Romain Basmaci

doi:10.3389/fped.2023.1245861

Impact of lockdown on children with type-1 diabetes: returning to the community was associated with a decrease in HbA1c

Front Pediatr. 2023 Dec 20:11:1245861. doi: 10.3389/fped.2023.1245861. eCollection 2023.

Authors

Benjamin Morat¹, Nadine Lucidarme², Auriane Gibert², Carole Harbulot¹, Noémie Lachaume¹, Stéphanie Gréteau¹, Romain Basmaci^{1

3}

Affiliations

¹ Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France.
² Service de Pédiatrie Générale, AP-HP, Hôpital Jean-Verdier, Bondy, France.
³ Université Paris Cité, Inserm, IAME, Paris, France.

Abstract

Background: In March 2020, a 2-month lockdown of the entire population has been declared in France to limit the spread of COVID-19. Sudden changes in daily life can impact the glycemic control of patients with type 1 diabetes (T1D), especially children and adolescents. We aimed to assess the impact of the lockdown on glycemic control in children and adolescents with T1D.

Methods: Children with T1D were prospectively recruited in two pediatric centers from May 11 to August 1, 2020. At inclusion, patients and/or parents were asked to fill in a form assessing the patient's lifestyle during the lockdown and a medical case report form was filled in by clinician. The mean of the three last glycated hemoglobin (HbA1c) values obtained before lockdown (HbA1c_mean; before March 17, 2020) was compared to the first HbA1c value measured after the lockdown (HbA1c_after; from May 11 to August 1, 2020). Univariable and multivariable analyses were performed, as appropriate, to identify factors associated with glycemic changes during lockdown.

Results: One-hundred-and-eighteen children and adolescents (median age was 14.1 years, 50% males) with T1D (median time from diagnosis was 4.1 years) were enrolled in the study. No significant difference was observed between medians of HbA1c_mean and HbA1c_after values (8.37% [7.88; 9.32%] vs. 8.50% [7.70; 9.50%], respectively; p = 0.391). Returning to the community was a protective factor [OR 0.31 (0.09-0.94); p = 0.045]. Patients having increased HbA1c were more frequently in contact with a suspected case of COVID-19 [OR 9.07 (2.15-53.66); p = 0.006], whereas patients having decreased HbA1c had the feeling of increase number of hypoglycemia [OR 0.19 (0.05-0.57); p = 0.006].

Conclusion: In our patients, HbA1c before and after the lockdown was stable. In subgroup analysis, returning to the community was a protective factor. In addition, feeling of hypoglycemia was more frequent in the patients with decreased HbA1c.

Keywords: COVID-19; HbA1c; SARS-CoV-2; children; diabetes mellitus; hypoglycemia; lockdown; pediatrics.