COVID-19 Pandemic Associated with Distress in Pediatric Type 1 Diabetes Population

Data show similar family impact and distress scores at baseline and 3-months, highlighting continued impact of COVID-19 on T1D population.

Erin Cobry, MD

Erin Cobry, MD

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.

In a new study, presented at the 2021 American Diabetes Association Virtual Meeting, investigators, led by Erin Cobry, MD, University of Colorado School of Medicine, collected data on the impact of COVID-19 on a pediatric population with type 1 diabetes (T1D).

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


The study enrolled parents and children aged 3 - 17 years, who were diagnosed with T1D prior to March 2020.

At baseline and 3 months, parents completed the CEFIS survey, including categories on exposure, impact, and distress.

The exposure section included 25 items with yes/no responses to measure exposure to COVID-19, as well as related events.

In addition, impact on CEFIS included 10 items on a 4-point Likert scale. The total impact score is considered the mean of 10 items, with a score above 2.5 indicating negative impact.

Finally, distress included 1 item each, for children and family, on a 10-point distress scale. Investigators noted higher scores indicated higher distress.

The baseline survey took place between August - November 2020, while the 3-month survey took place between December 2020 - February 2021.

Investigators stratified baseline scores by age and duration of T1D. They noted that children answered an additional question about the stay-at-home guidelines and its effect on their medical condition.


A total of 108 children were included in the study, with 57.4% male and a mean T1D duration of 5.3 years.

At baseline, data show that children <12 years (n = 58) had a mean exposure score of 7.43, while children aged ≥12 years had an exposure rate of 7.9, at P = .388.
In addition, exposure rates had a mean score of 7.8 in children with T1D duration <1 year (n = 13) and 7.6 in children with a T1D exposure of ≥1 year (n = 95).

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.

After CEFIS scores, investigators collected data once more on exposure, family impact, and distress.

At baseline, exposure scores were considered low at a mean score of 7.63±2.56. Further, scores after 3-months were similar at 7.50±2.93.

However, the team noted that a negative impact on families was reported at both baseline (2.74±0.57) and 3-months (2.71±0.60).

The team also observed distress at baseline (4.86±2.05) and at 3-months (4.72±2.06), at P = .503.

Data show 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 team concluded that despite low exposure rates, COVID-19 showed negative effects on families, highlighting similar family impact and distress scores at baseline and 3-month.

While children reported that staying-at-home did not change their self management, investigators noted that additional research is needed to assess the impact of the pandemic on T1D management.

“Healthcare providers and researchers need to consider distress associated with the COVID-19 pandemic during routine T1D care and T1D clinical research," investigators wrote.

The study, “Family Exposure and Impact of COVID-19 on a Pediatric T1D Population,” was published online by ADA.

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