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      Lessons learned from the continuous glucose monitoring metrics in pediatric patients with type 1 diabetes under COVID-19 lockdown

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          Abstract

          Aims

          Billions of people have been under lockdown in an attempt to prevent COVID-19 spread. Lifestyle changes during lockdown could lead to deterioration of glycemic control in type 1 diabetes (T1D). We aimed to assess the impact of COVID-19 lockdown on the glycemic control of pediatric patients with T1D.

          Methods

          This observational real-life study from the AWeSoMe Group assessed continuous glucose monitoring (CGM) metrics of 102 T1D patients (52.9% males, mean age 11.2 ± 3.8 years, mean diabetes duration 4.2 ± 3.8 years) who used  Dexcom G5. The data were accessed without any interface between patients, caregivers, and the diabetes team. Study variables from CGM metrics were: mean glucose level, time-in-range (TIR, 70–180 mg/dL; 3.9–10 mmol/L), hypoglycemia (< 54 mg/dL; < 3 mmol/L), hyperglycemia (> 250 mg/dL; > 13.3 mmol/L), coefficient of variation (CV), and time CGM active before and during lockdown. Delta-variable = lockdown variable minus before-lockdown variable.

          Results

          The mean TIR was 60.9 ± 14.3% before lockdown, with no significant change during lockdown (delta-TIR was 0.9 ± 7.9%). TIR during lockdown was significantly correlated with TIR before lockdown ( r = 0.855, P < 0.001). Patients with improved TIR (delta-TIR > 3%) were significantly older than patients with stable or worse TIR ( P = 0.028). Children aged < 10 years had a significantly higher CV before lockdown and during lockdown than children aged ≥ 10 years ( P = 0.02 and P = 0.005, respectively). Among children aged < 10 years, a multiple linear regression model revealed associations of age and lower socioeconomic cluster with delta-TIR ( F = 4.416, P = 0.019) and with delta-mean glucose ( F = 4.459, P = 0.018).

          Conclusions

          CGM metrics in pediatric patients with T1D were relatively stable during a nationwide lockdown. Intervention plans should focus on younger patients with lower socioeconomic position.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

            Qun Li, Xuhua Guan, Peng Wu … (2020)
            Abstract Background The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. Methods We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. Results Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). Conclusions On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.)
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              The Socio-Economic Implications of the Coronavirus and COVID-19 Pandemic: A Review

              Maria R.C. Nicola, Zaid Alsafi, Catrin Sohrabi … (2020)
              The COVID-19 pandemic has resulted in over 1.4 million confirmed cases and over 83,000 deaths globally. It has also sparked fears of an impending economic crisis and recession. Social distancing, self-isolation and travel restrictions forced a decrease in the workforce across all economic sectors and caused many jobs to be lost. Schools have closed down, and the need of commodities and manufactured products has decreased. In contrast, the need for medical supplies has significantly increased. The food sector has also seen a great demand due to panic-buying and stockpiling of food products. In response to this global outbreak, we summarise the socio-economic effects of COVID-19 on individual aspects of the world economy.
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                Author and article information

                Contributors
                Avivit Brener:
                ORCID: http://orcid.org/0000-0002-2742-8264
                Avivit.brener@gmail.com , avivitb@tlvmc.gov.il
                Journal
                Journal ID (nlm-ta): Acta Diabetol
                Journal ID (iso-abbrev): Acta Diabetol
                Title: Acta Diabetologica
                Publisher: Springer Milan (Milan )
                ISSN (Print): 0940-5429
                ISSN (Electronic): 1432-5233
                Publication date (Electronic): 7 October 2020
                Pages: 1-7
                Affiliations
                [1 ]GRID grid.413449.f, ISNI 0000 0001 0518 6922, Pediatric Endocrinology and Diabetes Unit, Dana Dwek Children’s Hospital, , Tel Aviv Sourasky Medical Center, ; 6 Weizmann Street, 6423906 Tel Aviv, Israel
                [2 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Sackler Faculty of Medicine, , Tel Aviv University, ; Tel Aviv, Israel
                [3 ]GRID grid.413795.d, ISNI 0000 0001 2107 2845, Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children’s Hospital, , Chaim Sheba Medical Center, ; Ramat-Gan, Israel
                [4 ]GRID grid.416216.6, ISNI 0000 0004 0622 7775, National Juvenile Diabetes Center, , Maccabi Health Care Services, ; Ra’anana, Israel
                [5 ]GRID grid.413990.6, ISNI 0000 0004 1772 817X, Pediatric Endocrinology Unit, , Shamir (Assaf Harofeh) Medical Center, ; Tzrifin, Israel
                [6 ]GRID grid.414259.f, ISNI 0000 0004 0458 6520, Pediatrics Department, , Barzilai Medical Center, ; Ashkelon, Israel
                [7 ]GRID grid.7489.2, ISNI 0000 0004 1937 0511, Faculty of Health Sciences, , Ben-Gurion University of the Negev, ; Beer-Sheva, Israel
                Author notes

                Managed by Antonio Secchi.

                Author information
                http://orcid.org/0000-0002-2742-8264
                Article
                Publisher ID: 1596
                DOI: 10.1007/s00592-020-01596-4
                PMC ID: 7538839
                PubMed ID: 33026497
                SO-VID: b3c793fd-a774-4a84-9151-7b76e0f1ebd3
                Copyright © © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 14 June 2020
                Date accepted : 12 August 2020
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: type 1 diabetes,children and adolescents,continuous glucose monitoring (cgm) metrics,ambulatory glucose profile,covid-19 lockdown
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: type 1 diabetes, children and adolescents, continuous glucose monitoring (cgm) metrics, ambulatory glucose profile, covid-19 lockdown

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