Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Section of Endocrinology, ASL Brindisi, DSS-1, Brindisi, Italy.
Diabetes Res Clin Pract. 2021 Oct;180:109066. doi: 10.1016/j.diabres.2021.109066. Epub 2021 Sep 23.
To assess the effects of lockdown due to COVID-19 pandemic on glucose metrics, measured by glucose monitoring systems, in adult individuals with type 1 diabetes.
We conducted a systematic literature search for English language articles from MEDLINE, Scopus and Web of Science up to February 28, 2021, using "diabetes", "lockdown", and "glucose" as key search terms. Time in range (TIR) was the main outcome; other metrics were time above range (TAR), time below range (TBR), mean blood glucose (MBG) and its variability (%CV), estimated HbA1c (eA1c) or glucose management indicator (GMI).
Seventeen studies for a total of 3,441 individuals with type 1 diabetes were included in the analysis. In the lockdown period, TIR 70-180 mg/dl increased by 3.05% (95% CI 1.67-4.43%; p < 0.0001) while TAR (>180 mg/dL and > 250 mg/dL) declined by 3.39% (-5.14 to -1.63%) and 1.96% (-2.51 to -1.42%), respectively (p < 0.0001 for both). Both TBR < 70 and <54 mg/dL remained unchanged. MBG slightly decreased by 5.40 mg/dL (-7.29 to -3.51 mg/dL; p < 0.0001) along with a reduction in %CV. Pooled eA1c and GMI decreased by 0.18% (-0.24 to -0.11%; p < 0.0001) and a similar reduction was observed when GMI alone was considered (0.15%, -0.23 to -0.07%; p < 0.0001). Sensor use was only slightly but not significantly reduced during lockdown.
This meta-analysis shows that well-controlled people with type 1 diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters.
评估 COVID-19 大流行期间的封锁对 1 型糖尿病成人患者通过血糖监测系统测量的血糖指标的影响。
我们使用“糖尿病”、“封锁”和“血糖”作为关键搜索词，对 MEDLINE、Scopus 和 Web of Science 上截至 2021 年 2 月 28 日的英文文章进行了系统文献检索。范围时间（TIR）是主要结局；其他指标包括血糖高于范围（TAR）、血糖低于范围（TBR）、平均血糖（MBG）及其变异性（%CV）、估计糖化血红蛋白（eA1c）或血糖管理指标（GMI）。
共有 17 项研究，总计 3441 名 1 型糖尿病患者纳入分析。在封锁期间，70-180mg/dL 的 TIR 增加了 3.05%（95%CI 1.67-4.43%；p<0.0001），而 TAR（>180mg/dL 和>250mg/dL）分别下降了 3.39%（-5.14 至-1.63%）和 1.96%（-2.51 至-1.42%）（均 p<0.0001）。TBR<70 和<T54mg/dL 保持不变。MBG 略有下降 5.40mg/dL（-7.29 至-3.51mg/dL；p<0.0001），同时 %CV 降低。汇总的 eA1c 和 GMI 分别下降 0.18%（-0.24 至-0.11%；p<0.0001），当仅考虑 GMI 时也观察到类似的降低（0.15%，-0.23 至-0.07%；p<0.0001）。在封锁期间，传感器的使用仅略有但无统计学意义的减少。
这项荟萃分析表明，接受 MDI 和 CSII 治疗且使用连续或闪光血糖监测的血糖控制良好的 1 型糖尿病患者在整个 COVID-19 封锁期间血糖控制没有恶化，许多血糖控制参数显示出适度但有统计学意义的改善。
