Improvement of Care & Outcome


Namam Ali, Soumia El Hamdaoui, Giesje Nefs, Cornelis J Tack, Bastiaan E De Galan

Improved glucometrics in people with type 1 diabetes 1 year into the COVID-19 pandemic. BMJ Open Diabetes Res Care . 2022 May;10(3):e002789.

During the first wave of the COVID-19 pandemic it was observed in a number of studies that over a few weeks various glycemic parameters improved in people with T1D (PWDs). However, these studies did not investigate factors associated with these glycemic improvements and if they were sustained during the following COVID-19 waves.


This study, co-authored by Giesje Nefs of Diabeter, aimed to evaluate glycemic parameters and associated factors 1 year after the start of the COVID-19 pandemic in a cohort of PWDs. In an observational cohort study 437 PWDs aged ≥ 16 years from the diabetes outpatient clinic of the Radboud University Medical Center were included.

Key findings:

  • Sensors were used by 84% of people (76% FGM, 8% rt-CGM) and 16% used SMBG. There were no differences between these groups in terms of age, sex, diabetes duration, HbA1c and most other clinical parameters.
  • Impaired awareness of hypoglycemia (IAH), hypoglycemia rate and pump use were higher in rt-CGM users vs FGM users. Compared with people on FGM, fewer people using SMBG were on pump treatment and their hypoglycemia rates were lower.
  • 22% of people had a score ≥8 for the Problem Areas in Diabetes (PAID-5) questionnaire, indicating possible diabetes-related emotional distress.
  • 45% of people reported any emotional distress due to the COVID-19 pandemic and 9% had worries about their diabetes and/or COVID-19.
  • About one fifth of people reported to aim for different blood glucose levels and to be more involved in their diabetes care in this period.
  • Changes in physical activity, diet and sleep duration after the first surge of the COVID-19 pandemic and associated lockdown measures were also reported.
  • HbA1c decreased from 7.9% (63 mmol/mol) before the lockdown to 7.5% (59 mmol/mol) 1 year later. HbA1c decrease was greater for:
    • men
    • people with baseline Hb1A1c ≥7.5%
    • people using FGM vs SMBG
    • people who started FGM after 1-1-2020 vs those started before this
    • people who smoked
  • COVID-19-related changes in psychological well-being or behavior were not associated with an HbA1c reduction ≥0.5%.
  • For people using FGM it could be determined that time in targeted blood glucose range (TIR) increased from 56% to 59% in this period. FGM activity increased from 70% to 87% and scanning frequency from 6% to 10%.



Concluding, the authors state

"“……….our study shows an association between COVID-19 pandemic and related lockdown measures with a clinically relevant improvement of various glycemic parameters in individuals with type 1 diabetes during 1-year follow-up. ………but further studies are needed to see whether and to what extent these improvements can be sustained after the COVID-19 pandemic-associated lockdown measures are lifted." -

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