Impact of changes in diabetes care models and advanced technologies on two-year glycemic control after COVID-19...

The COVID-19 pandemic led to significant shifts in lifestyle and clinical management for individuals with Type 1 Diabetes (T1D) that, during the COVID-19 lockdown, showed an improved glycemic control, characterized by increased time-in-range (TIR) and reduced glucose variability. This study aimed to assess the long-term trends and factors influencing glycemic control over two years post-lockdown in adults with T1D.

A longitudinal study was conducted on 207 adults with T1D (mean age 38 ± 13 years), with 50.2% using multiple daily insulin injections and 49.8% on continuous subcutaneous insulin infusion. Continuous glucose monitoring (CGM) metrics-including TIR, time-above-range (TAR); time-below-range (TBR), and coefficient of variation (CV)- were assessed before, during, and at 6, 12, and 24 months post-lockdown. Participants also completed an online questionnaire evaluating lifestyle habits before, during, and one year after lockdown.

The glycemic improvements observed during lockdown persisted for two years. TIR 70-180 mg/dl remained significantly higher, while TAR > 250 mg/dl and TBR < 54 mg/dl were significantly lower at all post-lockdown time points (p < 0.05 for all). These improvements were not attributed to lifestyle changes, which remained relatively stable one year after lockdown. Telemedicine was implemented being the prevalent model of care during this period. Notably, the improvement in glycemic control concerned the participants transitioning to advanced insulin delivery systems during the two-year observational period (p < 0.001).

Glycemic control improvements in adults with T1D were sustained for two years post-lockdown and related to transitioning to more advanced insulin delivery systems.