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      Weight gain in type 1 diabetes during the SARS-CoV-2 pandemic. Does lockdown affect the metabolic control of pediatric patients?

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          Abstract

          Background and aims

          Due to the severe acute respiratory syndrome coronavirus 2 pandemic, governments of many countries decided to implement lockdowns, which included school closures. This major lifestyle change also applied to people with diabetes. The aim of this paper was to analyze how the COVID-19 pandemic and related restrictions influenced the metabolic compensation of diabetes in the pediatric population.

          Methods

          Patients with type 1 diabetes (T1D), treated by one therapeutic team, who in 2020 and 2021 paid at least two in-person visits in the outpatient clinic, were included in the study. The time in range (TIR) and HbA1c, as well as the total daily dose (TDD) of insulin and BMI from the visit before the announcement of the pandemic restrictions (March 2020) and during the lockdown (second visit after 6 months) and within the period of loosened restrictions (two visits in 2021) were analyzed.

          Results

          A total of 185 patients with T1D were included in the study (96 boys), aged 2–18 years (11.5 ± 3.5); 135 of them (72.9%) use CSII and 142 (76.8%) use CGM or FGM. During the first months of the studied period, despite comparable (p>0.05) TIR (57.5 ± 21.4% vs. 59.9 ± 20.5%), improvement of HbA1c was noticed (7.9 ± 1.6% vs. 7.5 ± 1.4%, p=0.0336), whereas in the following months, both HbA1c and TIR were comparable. Also, the TDD increased significantly (from 37.3 ± 18.9 units/day on the first visit up to 46.8 ± 22.7 units/day on the last visit, p=0.0003); however, TDD/kg remained constant (p>0.05) (0.8 ± 0.2 units/kg/day vs. 0.8 ± 0.3 units/kg/day) possibly due to an increased BMI (19.1 ± 3.7 kg/m 2 vs. 20.9 ± 4.1 kg/m 2, p=0.0001). The percentage of basal insulin in the TDD remained stable (p>0.05) (39.7 ± 11.3% vs. 39.3 ± 13.6%). Furthermore, a significant (p=0.0001) change in the BMI percentile was noticed [from 58.9 ± 26.2 percentiles (%iles) before lockdown vs. 64.6 ± 26.0%iles on the second visit]. However, the BMI percentile returned to baseline (58.1 ± 28.4%iles) at the visit at the end of the observation period.

          Conclusions

          The parameters of metabolic control in pediatric patients with T1D during the pandemic period remained stable; however, weight gain and an increase in daily insulin dose have been observed, possibly due to reduced physical activity.

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          Most cited references42

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          Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak

          Highlights • The novel coronavirus (2019-nCoV) pneumonia has caused 2033 confirmed cases, including 56 deaths in mainland China, by 2020-01-26 17:06. • We aim to estimate the basic reproduction number of 2019-nCoV in Wuhan, China using the exponential growth model method. • We estimated that the mean R 0 ranges from 2.24 to 3.58 with an 8-fold to 2-fold increase in the reporting rate. • Changes in reporting likely occurred and should be taken into account in the estimation of R 0.
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            Effects of COVID‐19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study

            Abstract Objective To test the hypothesis that youths with obesity, when removed from structured school activities and confined to their homes during the COVID‐19 pandemic, will display unfavorable trends in lifestyle behaviors. Methods The sample included 41 children and adolescents with obesity participating in a longitudinal observational study located in Verona, Italy. Lifestyle information including diet, activity, and sleep behaviors were collected at baseline and three weeks into the national lockdown during which home confinement was mandatory. Changes in outcomes over the two study time points were evaluated for significance using paired t‐tests. Results There were no changes in reported vegetable intake; fruit intake increased (p=0.055) during the lockdown. By contrast, potato chip, red meat, and sugary drink intakes increased significantly during the lockdown (p‐value range, 0.005 to <0.001). Time spent in sports activities decreased (X±SD) by 2.30±4.60 hours/week (p=0.003) and sleep time increased by 0.65±1.29 hours/day (p=0.003). Screen time increased by 4.85±2.40 hours/day (p<0.001). Conclusions Recognizing these adverse collateral effects of the COVID‐19 pandemic lockdown is critical in avoiding depreciation of weight control efforts among youths afflicted with excess adiposity. Depending on duration, these untoward lockdown effects may have a lasting impact on a child’s or adolescent’s adult adiposity level.
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              Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland

              The outbreak of coronavirus disease (COVID-19) in late December 2019 in China, which later developed into a pandemic, has forced different countries to implement strict sanitary regimes and social distancing measures. Globally, at least four billion people were under lockdown, working remotely, homeschooling children, and facing challenges coping with quarantine and the stressful events. The present cross-sectional online survey of adult Poles (n = 1097), conducted during a nationwide quarantine, aimed to assess whether nutritional and consumer habits have been affected under these conditions. Over 43.0% and nearly 52% reported eating and snacking more, respectively, and these tendencies were more frequent in overweight and obese individuals. Almost 30% and over 18% experienced weight gain (mean ± SD 3.0 ± 1.6 kg) and loss (−2.9 ± 1.5 kg), respectively. Overweight, obese, and older subjects (aged 36–45 and >45) tended to gain weight more frequently, whereas those with underweight tended to lose it further. Increased BMI was associated with less frequent consumption of vegetables, fruit, and legumes during quarantine, and higher adherence to meat, dairy, and fast-foods. An increase in alcohol consumption was seen in 14.6%, with a higher tendency to drink more found among alcohol addicts. Over 45% of smokers experienced a rise in smoking frequency during the quarantine. The study highlights that lockdown imposed to contain an infectious agent may affect eating behaviors and dietary habits, and advocates for organized nutritional support during future epidemic-related quarantines, particularly for the most vulnerable groups, including overweight and obese subjects.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/1337337
                URI : https://loop.frontiersin.org/people/1874606
                Journal
                Front Endocrinol (Lausanne)
                Front Endocrinol (Lausanne)
                Front. Endocrinol.
                Frontiers in Endocrinology
                Frontiers Media S.A.
                1664-2392
                12 October 2022
                2022
                12 October 2022
                : 13
                : 991269
                Affiliations
                [1] Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University , Wrocław, Poland
                Author notes

                Edited by: Stefano Stagi, University of Florence, Italy

                Reviewed by: Bryce Allen Nelson, Children’s Hospital of Richmond at VCU, United States; Barbara Glowinska-Olszewska, Medical University of Bialystok, Poland

                *Correspondence: Agnieszka Zubkiewicz-Kucharska, agnieszka.zubkiewicz-kucharska@ 123456umed.wroc.pl

                This article was submitted to Pediatric Endocrinology, a section of the journal Frontiers in Endocrinology

                Article
                10.3389/fendo.2022.991269
                9597863
                36313778
                1b04671b-b40d-49af-acf0-66963d1c184d
                Copyright © 2022 Zubkiewicz-Kucharska, Wikiera and Noczyńska

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 11 July 2022
                : 08 September 2022
                Page count
                Figures: 3, Tables: 4, Equations: 0, References: 44, Pages: 10, Words: 5505
                Funding
                Funded by: Uniwersytet Medyczny im. Piastów Slaskich we Wroclawiu , doi 10.13039/501100009687;
                Categories
                Endocrinology
                Original Research

                Endocrinology & Diabetes
                bmi,metabolic control,type 1 diabetes,covid-19 lockdown,children
                Endocrinology & Diabetes
                bmi, metabolic control, type 1 diabetes, covid-19 lockdown, children

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