COVID-19 Lockdowns Lead to Increase in HbA1c in Diabetes Patients

Changes in physical activity and diet may be main cause for worsening of diabetes control.

While effective in curbing the spread of COVID-19, lockdowns and shelter-in-place orders have had a profound impact on patients with other diseases and conditions.

There have been studies conducted since the beginning for the pandemic showing type 1 diabetes mellitus patients have demonstrated a short-term favorable or neutral effect of the lockdown on glycemic parameters.

However, the data on this connection is limited for type 2 diabetes mellitus patients.

In a late-breaking poster presented during the 2021 American Diabetes Association Virtual Meeting, a team, led by Is-Haq O. Malik, MD, Resident Physician, BronxCare Health System, identified how the lockdown affected the glycemic control of adult patients with type 2 diabetes mellitus within a specific region of New York.

The Patients

In the retrospective cohort data, the researchers analyzed data from patients with regular outpatient visits within an integrated-delivery health system in South Bronx.

Each patient had A1C levels measured within 6 months prior to the initiation of lockdown in March of 2020 and a repeat A1C within 3 months after the first phase of reopening in New York in June of 20 20.

The researchers used paired samples T-tests to analyze the comparison between pre- and post-lockdown HbA1c values.

The study included 2489 adult patients with an established diagnosis of type 2 diabetes mellitus and A1C levels available.

An additional, 632 patients were excluded due to pregnancy, prediabetes, new-onset diabetes, residency in long-term care facility or hospital admission during the study period. The mean age of the patient population was 61 years old and 58% of the patients were female.

Results

Overall, there was a mean pre-lockdown A1C of 7.64% and a mean post-lockdown A1C of 7.76%, indicating an increase of 0.122% (95% CI, 0.0613-0.1827).

“The COVID-19 lockdown was associated with a small but statistically significant increase in HbA1C levels (0.122%) in a large cohort of community-dwelling adult patients with type 2 diabetes in South Bronx,” the authors wrote. “Interruptions to regular outpatient care, difficulty in obtaining medications from pharmacies, changes in physical activity or diet and psychological stress related to the pandemic may have been potential contributing factors and need to be addressed to avoid further worsening of diabetes control in the longer term.”

COVID-19’s Impact

In another study presented during ADA, researchers found the COVID-19 pandemic resulted in consequences on morbidity and mortality, with diabetes considered a significant contributor to complications related to infection of the virus.

Using the COVID-19 Family Exposure and Impact Survey (CEFIS), a team from the University of Colorado School of Medicine found the COVID-19 pandemic impacted families of children with T1D, despite lack of direct exposure to the virus.

Distress rates were higher with children aged <12 years with a mean score of 4.9 and in children with T1D duration of <1 year with a mean score of 5.5.

Data shows children's response to COVID-19 stay-at-home guidelines, when 51.1% of children at baseline reported no change and 61.9% of children reported it stayed the same after 3-months.

The study, “Effect of the COVID-19 Lockdown on Glycemic Control in Adult Patients with Type 2 Diabetes Mellitus,” was published online by ADA.