ESPE Abstracts

Introduction: The COVID-19 pandemic led to regional lockdowns and restrictions associated with changes in lifestyle and quality of life (QoL) thus potentially burdening metabolic control in Diabetes Mellitus (DM). We examined whether the stages of restrictions lead to changes in QoL and metabolic control in children with DM.

Methods: Starting in April 2020, this monocentric prospective longitudinal cohort study included children attending the outpatient diabetes clinic at a tertiary children’s hospital. In addition to the repeated assessment of SARS-CoV-2 antibodies and symptoms, screen time and physical activity, reported elsewhere, health-related QoL (HrQoL) through Kidscreen-10 (T-scores >50 represent a better, <50 a poorer QoL than the reference population), BMI-SDS, HbA1c, mean glucose (MG), variability (%CV) and Time in Range (TIR) were assessed at 2-3-monthly scheduled visits. Parameters were assigned to the following pandemic phases:

1: 16.03.20 – 10.05.20 Lockdown with closed schools, shops, restaurants and social activities

2: 11.05.20 – 18.10.20 no restrictions

3: 19.10.20 – 21.12.20 slowdown with assembly restrictions and business closing hours

4: 22.12.20 – 28.02.21 lockdown with closed shops, restaurants and social activities, but open schools For statistical analysis, we applied mixed-model-analysis between different phases and Pearson double-sided correlations.

Results: We assessed 54 children with Type1DM and two with MODY, 53.4% male and 46.6% female and median age of 12 years (range 1 – 19); Median HbA1c during phase 1 was 7.5% (range 6.2 – 11.0%). BMI-SDS, HbA1c, MG, %CV and TIR did not significantly change during all 4 phases. During lockdown phase 1 HbA1c (P = 0.003) and %CV (P = 0.05) were significantly correlated with increasing age. The HbA1c decrease from phase 1 to 2 was greater the older the patients were (P = 0.029). The HrQoL showed significant increase from phase 1 to 2, decreased HrQoL mean scores in phases with high restrictions (1: 46.7 (32.2 - 65.2), 3-4: 46.7 (36.4 - 77.1)), or after back to school in Phase 2 (46.7 (31.3 - 83.5)), but normal T-scores during the rest phase 2 (50.7, 32.4 - 83.6).

Conclusions: The children with DM participating in the study showed a stable metabolic control through different phases of the pandemic, despite impaired HrQoL during phases with higher restrictions. Nevertheless, in older patients, metabolic control was transiently compromised during school closure. Consistent with prior studies, children with diabetes seem to activate sufficient resources for their diabetes management even during the COVID-19 pandemic if they have a regular (school) routine and medical care; other authors substantiate the importance of parental support.