COVID-19 “lockdown” had different and opposite effects on blood glucose control in people with type 1 versus type 2 diabetes, according to a new analysis published in the journal Diabetology & Metabolic Syndrome.
The COVID-19 pandemic has had a disproportionate impact on people with diabetes, as a recent research review made clear — including a fatality rate of about 25% among hospitalized COVID-19 patients with diabetes. This review found that the risk for severe disease or death from COVID-19 was 100% to 250% higher in people with diabetes, compared with those without diabetes. It also found that among excess deaths in people with diabetes since the pandemic began — deaths in excess of the pre-pandemic rate — 75% to 85% were not officially listed as being from COVID-19. This means either that many people with diabetes are getting COVID-19 without knowing it, or that the pandemic has increased the death rate in other ways — or both.
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Pandemic effects on glucose control
The latest analysis sheds some light on a possible explanation for some excess deaths in people with diabetes — worse glucose control in people with type 2 since the start of the pandemic. Researchers looked at several studies that explored the impact of COVID-19 restrictions on blood glucose control in 2,881 people with type 1 diabetes and 1,823 people with type 2 diabetes. They found that 72% of these studies (18 out of 25) showed improved blood glucose control in people with type 1, and that 50% of studies (four out of eight) showed worsened blood glucose control in people with type 2. A combined analysis of studies involving people with type 1 showed an average drop in A1C (a measure of long-term blood glucose control) of 0.05% during the lockdown period, while the same type of analysis found an average A1C increase of 0.14% among people with type 2.
When it came to the amount of time spent in a target glucose range of 70 mg/dl to 180 mg/dl, the researchers found that people with type 1 increased their time in range by an average of 3.75% during the lockdown period. In fact, 83% of studies that looked at this outcome (15 out of 18) found an improvement in time in range among people with type 1. There wasn’t enough data on time in range among people with type 2 diabetes to calculate any outcomes.
The researchers speculated that the improved blood glucose control seen in people with type 1 “could be due to more time for self-care and more time to concentrate on [diabetes] management. In the case of children, it may be because the parents who were forced to ‘stay home’ had more time to deal with the disease and family environment may be more attentive in diabetes management.” When it came to possible explanations for worse glucose control in people with type 2, they cited other research showing “an association between levels of foods cravings and snack consumption as well as high percentage of physical inactivity before the COVID-19 lockdown which intensified during the home confinement.” Other potential factors, they wrote, could include poor sleep, increased sitting time, or increased financial difficulties related to lockdown and the pandemic in general.
Limitations of their analysis, the researchers wrote, included a small number of relevant studies involving people with type 2 diabetes and fact that “lockdown” measures in different studies varied widely based on location. More studies are needed to evaluate the impact of different type of restrictions on blood glucose control, especially in people with type 2 diabetes.
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