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06-08-2020 | Diabetes | News | Article

Socioeconomic status may flag glycemic control deterioration risk in COVID-19 lockdown

Eleanor McDermid

medwireNews: Analysis of flash glucose monitoring users in Scotland reveals that people with low socioeconomic status had an increased risk for deteriorating glycemic control during the COVID-19 lockdown.

In line with previous studies, the researchers found that flash monitoring variables for 572 people with type 1 diabetes between March and May 2020 (a large part of the period of lockdown in Scotland) showed changes that were “broadly consistent with improved glycaemic control.”

For example, average time in range (blood glucose 3.9–10.0 mmol/L [70–180 mg/dL]) improved significantly from 53% to 56%, and there were significant improvements in average glucose, some measures of glucose variability, and estimated glycated hemoglobin (HbA1c). There were also significant improvements when the lockdown period was compared to the equivalent period in 2019.

“Whilst there are a number of reasons to suspect that lockdown conditions could have a deleterious effect on glycaemic control in people with type 1 diabetes, this was not observed in a large cohort of individuals using flash glucose monitoring,” write Fraser Gibb (University of Edinburgh, UK) and study co-authors in Diabetic Medicine.

“In fact, these data suggest that, overall, there has been a small but significant improvement in important metrics such as time in range and estimated HbA1c.”

However, the team cautions that although the large cohort allowed them to detect statistically significant differences, the magnitude of these changes “would not be considered to be clinically meaningful.”

Contrary to the general improvement, 22% of people had a decline in time in range by at least 5% during lockdown.

One independent predictor of a decline in time in range was having a high time in range at baseline, which the researchers say is “unsurprising” and “may simply reflect regression to the mean.”

They say: “Of potentially greater interest is the observation that higher levels of socio-economic deprivation were a strong, independent predictor of deteriorating glycaemic control during lockdown.”

Being in the highest two socioeconomic quintiles, as opposed to the lowest three, was associated with a significant 55% reduced likelihood of having a decline in time in range during lockdown, and a 59% reduced likelihood of having an 0.5% (5 mmol/mol) or greater increase in HbA1c.

Gibb and team caution that their study findings are applicable mainly to proactive flash monitoring users, and to younger and more affluent people, despite the technology now being fully funded in the UK.

But they say the impact of socioeconomic status on glycemic control is well established, and there are “several plausible” reasons why the pandemic could have contributed to this association, such as affecting access to healthy food and exercise and creating additional stress and uncertainty relating to childcare, employment, and income.

“This has important implications for service design to provide more effective support to those who require it most, particularly in challenging times,” the team concludes.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

6 August 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Diabet Med 2020; doi:10.1111/dme.14374

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