Effects of work status changes and perceived stress on glycaemic control in individuals with type 1 diabetes during COVID-19 lockdown in Italy

Aims: To evaluate the effects of COVID-19 lockdown on blood glucose control in individuals with type 1 diabetes (T1D) and to explore determinants of glucose variability. Methods: Fifty T1D patients undergoing continuous/flash glucose monitoring were recruited. The study's primary outcome was the change of time in range (TIR) from before to lockdown period. Three time-point comparisons of TIR, mean glucose levels (MG), estimated (e)HbA1c, time above (TAR) and below range (TBR), moderate/severe hypoglycemic events between pre-lockdown, lockdown and post-lockdown period were also performed. Information on lockdown-associated perceived stress, changes of work status and physical activity were recorded. Results: TIR significantly decreased (75(63–84)% vs. 69(50–76)%, p < 0.001) whereas MG ( 154 ± 15 mg/dl vs. 165 ± 25 mg/dl, p = 0.027) and eHbA1c (7.3(6.6–7.8)% vs. 7.5(6.7–8.2)%, p = 0.031) increased from pre- to lockdown period; overall glucose control significantly improved when restriction ended. Lockdown-associated work loss/suspension independently predicted impaired TIR after adjustment for potential confounders (Standardized β: −0.29; 95%CΙ: −18.7 to −2.25; p = 0.01). Greater TAR, TBR and hypoglycemic events were also reported during the lockdown. Conclusion: In T1D Italian individuals, blood glucose control significantly worsened during the COVID-19 lockdown; work instability and related issues represented the main determinant of impaired glucose variability in this population