Impact of advanced technologies on 2-y glycemic control after COVID lockdown in adults with T1D

Background: The COVID-19 pandemic precipitated significant shifts in the lifestyle and clinical management of individuals with Type 1 Diabetes (T1D), and blood glucose control was improved during lockdown. Aims: This study assessed the trend and the factors influencing glycemic control over the two years following the COVID-19 lockdown in adults with T1D. Methods: We conducted a longitudinal study on 207 adults with T1D, 96 females and 111 males, age 38±13 years, 50.2% on multiple daily insulin injections and 49.8% on continuous subcutaneous insulin infusion, utilizing continuous glucose monitoring (CGM) systems. CGM metrics (TIR, time in range; TAR, time above range; TBR, time below range; CV, coefficient of variation) were evaluated before and during lockdown, and after 6, 12, and 24 months. An online questionnaire assessed lifestyle habits before, during, and one year after lockdown. Results: The improvement in glycemic control observed during the lockdown persisted for the following two years. Compared to before lockdown, TIR (70-180 mg/dl) was significantly higher, while TAR (180-250 mg/dl and >250 mg/dl) and TBR (<54 mg/dl) were significantly lower at all post-lockdown measurements (p<0.05 for all). Glucose improvement was not related to changes in lifestyle habits that were relatively unchanged one year after compared to during lockdown. During this period, a high percentage (85%) of patients utilized remote visits. At 2 years, TIR (69.0±14.8% vs 54.7±17.3%; p<0.001) was significantly higher and TAR >180 mg/dl (21.1±8.15% vs 26.8±10.2%; p<0.001) and TBR<70 mg/dl (1.65±1.81% vs 2.83±3.10%; p=0.004) were significantly lower in the participants who transitioned to advanced insulin delivery systems (n=70) compared to those who did not (n=125). Conclusions: Adults with T1D experienced sustained improvement in glycemic control up to two years after the COVID-19 lockdown, largely independent of significant lifestyle changes. This trend was related to the increased adoption of advanced diabetes-related technologies.