Diabetes care practices and outcomes in 40.000 children and adolescents with type 1 diabetes from the SWEET registry during the COVID-19 pandemic

Agata Chobot; Stefanie Lanzinger; Hessa Alkandari; G Todd Alonso; Nicole Blauensteiner; Nicole Coles; Luisa De Sanctis; Dick Mul; Banshi Saboo; Carmel Smart; Meng-Che Tsai; Bedowra Zabeen; Klemen Dovc

doi:10.1016/j.diabres.2023.110809

Diabetes care practices and outcomes in 40.000 children and adolescents with type 1 diabetes from the SWEET registry during the COVID-19 pandemic

Diabetes Res Clin Pract. 2023 Aug:202:110809. doi: 10.1016/j.diabres.2023.110809. Epub 2023 Jun 27.

Authors

Affiliations

¹ Institute of Medical Sciences, University of Opole, Department of Pediatrics, Opole, Poland; University Clinical Hospital in Opole, Department of Pediatrics, Opole, Poland. Electronic address: agata.chobot@uni.opole.pl.
² Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
³ Dasman Diabetes Institute, Department of Populational Health, Kuwait.
⁴ University of Colorado, Anschutz Medical Campus, Barbara Davis Center, Aurora, CO, USA.
⁵ Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
⁶ Markham Stouffville Hospital, Markham, Ontario, Canada.
⁷ Department of Pediatric Endocrinology, Regina Margherita Children Hospital, Torino - Department of Public Health and Pediatric Sciences, University of Torino, Italy.
⁸ Diabeter, Centre for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands.
⁹ Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India.
¹⁰ Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital and School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.
¹¹ Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹² BADAS Paediatric Diabetes Care and Research Center, BIRDEM Hospital, Dhaka, Bangladesh.
¹³ University Medical Center Ljubljana, University Children's Hospital, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

Abstract

Aims: This study aimed to provide a global insight into initiatives in type 1 diabetes care driven by the COVID-19 pandemic and associations with glycemic outcomes.

Methods: An online questionnaire regarding diabetes care before and during the pandemic was sent to all centers (n = 97, 66,985 youth with type 1 diabetes) active in the SWEET registry. Eighty-two responded, and 70 (42,798 youth with type 1 diabetes) had available data (from individuals with type 1 diabetes duration >3 months, aged ≤21 years) for all 4 years from 2018 to 2021. Statistical models were adjusted, among others, for technology use.

Results: Sixty-five centers provided telemedicine during COVID-19. Among those centers naive to telemedicine before the pandemic (n = 22), four continued only face-to-face visits. Centers that transitioned partially to telemedicine (n = 32) showed a steady increase in HbA1c between 2018 and 2021 (p < 0.001). Those that transitioned mainly to telemedicine (n = 33 %) improved HbA1c in 2021 compared to 2018 (p < 0.001).

Conclusions: Changes to models of care delivery driven by the pandemic showed significant associations with HbA1c shortly after the pandemic outbreak and 2 years of follow-up. The association appeared independent of the concomitant increase in technology use among youth with type 1 diabetes.

Keywords: Children; Covid-19; Diabetes care; Diabetes ketoacidosis; HbA1c; Type 1 diabetes.

MeSH terms

Adolescent
COVID-19* / epidemiology
Child
Diabetes Mellitus, Type 1* / epidemiology
Diabetes Mellitus, Type 1* / therapy
Glycated Hemoglobin
Humans
Pandemics
Registries
Telemedicine*

Substances

Glycated Hemoglobin