Daniel Tajdar, Dagmar Lühmann, Laura Walther, Lasse Bittner, Martin Scherer, Ingmar Schäfer
{"title":"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","authors":"Daniel Tajdar, Dagmar Lühmann, Laura Walther, Lasse Bittner, Martin Scherer, Ingmar Schäfer","doi":"10.1007/s13300-024-01574-x","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>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 (<i>N</i> = 2370) by performing multivariable linear regressions.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>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 <i>β</i> = 0.23, 95% confidence interval (CI) 0.07–0.39, <i>p</i> = 0.005; during the second lockdown, <i>β</i> = 0.27, 95% CI 0.15–0.38, <i>p</i> < 0.001). HbA1c change during lockdowns was significantly affected by the number of checkups (<i>β</i> = −0.03, 95% CI −0.05 to −0.01, <i>p</i> = 0.010), the value of HbA1c at previous observation (<i>β</i> = 0.33, 95% CI 0.29–0.36, <i>p</i> < 0.001), educational level (secondary versus tertiary: <i>β</i> = 0.22, 95% CI 0.06–0.38, <i>p</i> = 0.008; primary versus tertiary: <i>β</i> = 0.31, 95% CI 0.10–0.52, <i>p</i> = 0.004), health literacy score (for each point: <i>β</i> = −0.03, 95% CI −0.05 to − 0.002, <i>p</i> = 0.034), and diabetes self-management score (for each point: <i>β</i> = −0.03, 95% CI −0.04 to −0.02, <i>p</i> < 0.001). The use of continuous glucose monitoring or insulin pump had no effect on HbA1c change.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Trial Registration</h3><p>ClinicalTrials.gov identifier, NCT04821921.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":"8 1","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"Daniel Tajdar, Dagmar Lühmann, Laura Walther, Lasse Bittner, Martin Scherer, Ingmar Schäfer\",\"doi\":\"10.1007/s13300-024-01574-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Introduction</h3><p>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.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>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 (<i>N</i> = 2370) by performing multivariable linear regressions.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>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 <i>β</i> = 0.23, 95% confidence interval (CI) 0.07–0.39, <i>p</i> = 0.005; during the second lockdown, <i>β</i> = 0.27, 95% CI 0.15–0.38, <i>p</i> < 0.001). HbA1c change during lockdowns was significantly affected by the number of checkups (<i>β</i> = −0.03, 95% CI −0.05 to −0.01, <i>p</i> = 0.010), the value of HbA1c at previous observation (<i>β</i> = 0.33, 95% CI 0.29–0.36, <i>p</i> < 0.001), educational level (secondary versus tertiary: <i>β</i> = 0.22, 95% CI 0.06–0.38, <i>p</i> = 0.008; primary versus tertiary: <i>β</i> = 0.31, 95% CI 0.10–0.52, <i>p</i> = 0.004), health literacy score (for each point: <i>β</i> = −0.03, 95% CI −0.05 to − 0.002, <i>p</i> = 0.034), and diabetes self-management score (for each point: <i>β</i> = −0.03, 95% CI −0.04 to −0.02, <i>p</i> < 0.001). The use of continuous glucose monitoring or insulin pump had no effect on HbA1c change.</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusions</h3><p>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.</p><h3 data-test=\\\"abstract-sub-heading\\\">Trial Registration</h3><p>ClinicalTrials.gov identifier, NCT04821921.</p>\",\"PeriodicalId\":11192,\"journal\":{\"name\":\"Diabetes Therapy\",\"volume\":\"8 1\",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-04-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diabetes Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s13300-024-01574-x\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13300-024-01574-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
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
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.
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.
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