两种 COVID-19 锁定疗法对 1 型糖尿病患者 HbA1c 水平的影响以及与数字化治疗、健康素养和糖尿病自我管理的关联：一项为期三年的多中心观察队列研究

IF 3.8 3区医学 Q2 Medicine

Diabetes Therapy Pub Date : 2024-04-20 DOI:10.1007/s13300-024-01574-x

Daniel Tajdar, Dagmar Lühmann, Laura Walther, Lasse Bittner, Martin Scherer, Ingmar Schäfer

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引用次数: 0

摘要

导言据短期研究报告，在 COVID-19 封锁期间，1 型糖尿病患者的血糖控制有所改善，eHbA1c（估计血红蛋白 A1c）有所下降，但长期变化尚不清楚。因此，研究的主要目的是：（1）分析实验室测量的 HbA1c 在两次封锁期间和封锁后是否发生了变化；（2）研究影响 HbA1c 变化的潜在变量。方法在这项队列研究中，对 291 名成年 1 型糖尿病患者进行了为期 3 年的随访，包括流行前阶段和两次封锁。结果中位年龄为 54（38-63）岁，男性为 159（54.6%）人。COVID-19 大流行的所有阶段都与实验室测量的 HbA1c 百分比水平的显著增加有关（例如，在第一次封锁期间，β = 0.23，95% 置信区间（CI）为 0.07-0.39，p = 0.005；在第二次封锁期间，β = 0.27，95% 置信区间（CI）为 0.15-0.38，p = 0.001）。封锁期间的 HbA1c 变化受检查次数（β = -0.03，95% CI -0.05 至 -0.01，p = 0.010）、上次观察时的 HbA1c 值（β = 0.33，95% CI 0.29-0.36，p <0.001）、教育程度（中学与大学：β = 0.22，95% CI 0.06-0.38，p = 0.008；初等与高等：β = 0.31，95% CI 0.10-0.52，p = 0.004）、健康素养评分（每点：β = -0.03，95% CI -0.05至-0.002，p = 0.034）和糖尿病自我管理评分（每点：β = -0.03，95% CI -0.04至-0.02，p <0.001）。结论停药会导致 1 型糖尿病患者的血糖控制恶化。尤其是检查次数少、血糖值低、糖尿病自我管理能力差、健康知识水平低和受教育程度低的患者，在停药期间血糖控制恶化的风险似乎更大，因此需要特殊的医疗护理，如通过远程医疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Effects of Two COVID-19 Lockdowns on HbA1c Levels in Patients with Type 1 Diabetes and Associations with Digital Treatment, Health Literacy, and Diabetes Self-Management: A Multicenter, Observational Cohort Study Over 3 Years

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Introduction

Short-term studies reported improved glycemic control and a decrease in eHbA1c (estimated hemoglobin A1c) in patients with type 1 diabetes during COVID-19 lockdown, but long-term changes are unknown. Therefore, the main objectives are to (1) analyze whether laboratory-measured HbA1c changed during and after two lockdowns and (2) investigate potential variables influencing HbA1c change.

Methods

In this cohort study, 291 adults with type 1 diabetes were followed over 3 years including the prepandemic phase and two lockdowns. The data from medical records and validated questionnaires assessing health literacy (HLS-EU-Q16), diabetes self-management (DSMQ-R27), general self-efficacy (GSE), and social support (F-SOZU-K14) were used to analyze associations with HbA1c levels (N = 2370) by performing multivariable linear regressions.

Results

The median age was 54 (38–63) years and 159 (54.6%) were male. All phases of the COVID-19 pandemic were associated with a significant increase in laboratory-measured HbA1c levels in percent (e.g., during first lockdown β = 0.23, 95% confidence interval (CI) 0.07–0.39, p = 0.005; during the second lockdown, β = 0.27, 95% CI 0.15–0.38, p < 0.001). HbA1c change during lockdowns was significantly affected by the number of checkups (β = −0.03, 95% CI −0.05 to −0.01, p = 0.010), the value of HbA1c at previous observation (β = 0.33, 95% CI 0.29–0.36, p < 0.001), educational level (secondary versus tertiary: β = 0.22, 95% CI 0.06–0.38, p = 0.008; primary versus tertiary: β = 0.31, 95% CI 0.10–0.52, p = 0.004), health literacy score (for each point: β = −0.03, 95% CI −0.05 to − 0.002, p = 0.034), and diabetes self-management score (for each point: β = −0.03, 95% CI −0.04 to −0.02, p < 0.001). The use of continuous glucose monitoring or insulin pump had no effect on HbA1c change.

Conclusions

Lockdowns can lead to worsening glycemic control in patients with type 1 diabetes. Particularly patients with few check-ups, poor blood glucose values, deficits in diabetes self-management, low health literacy, and a low level of education seem to be at greater risk of worsening glycemic control during lockdowns and, therefore, require special medical care, e.g., through telemedicine.

Trial Registration

ClinicalTrials.gov identifier, NCT04821921.

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来源期刊

Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.90

自引率

7.90%

发文量

130

审稿时长

6 weeks

期刊介绍： Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.