CGM, Telemedicine Likely Buttressed Pediatric T1D Care During the Pandemic

Adverse changes were not seen in depression screening via Patient Health Questionnaire-9 (PHQ-9), hospitalization frequency, and glycemic control among pediatric patients receiving care for type 1 diabetes (T1D) before and after COVID-19 restrictions were imposed in Dallas County on March 15, 2020, according to new findings published in BMC Pediatrics.

Outcomes were compared among 1600 patients of Children’s Medical Center Dallas for 2 periods: Those in the baseline 2019 (pre-COVID) group received care between March 15, 2019, and March 14, 2020, and those in the 2020 (post-COVID) group received care between March 15, 2020, and March 14, 2021. In addition to the above, all were evaluated for disease characteristics, in-person and virtual outpatient encounters, and continuous glucose monitor (CGM) utilization; had to have at least 1 patient encounter; and were considered CGM users if data were available for their study group year.

The COVID-19 pandemic has greatly impacted glycemic control among patients with diabetes, the authors noted. This—coupled with the fact that pediatric patients with T1D tend to have higher rates of diabetic ketoacidosis (DKA) if they have noncommercial insurance coverage, are of a minority race or ethnicity, and have higher glycated hemoglobin (A1C)—stresses the importance of good glycemic control to prevent severe cases of COVID-19 or death.

The mean (SD) patient age in the study was 13.8 (3.6) years and most were male (52.8%) or White (53.5%) with commercial insurance (60.3%). The virtual visit platform was put in place on April 1, 2020, following stoppage of in-person clinic visits on March 16, 2020.

Their analysis determined the following:

• Total outpatient visits did not change significantly for patients with noncommercial insurance vs those with commercial coverage, who had marked decreases.
• Virtual visit platform use did not differ by insurance status.
• Hospitalization frequency from 2019 to 2020 did not change in either insurance status group.
• Patients with noncommercial insurance had higher overall hospitalization frequencies (P < .0001), particularly because of hyperglycemia and DKA; however, DKA alone did not influence this outcome (271 visits in 2019 vs 270 in 2020).
• Higher A1C measures correlated with older age, having noncommercial insurance, Black and Hispanic race/ethnicity, and nonuse of CGMs (P < .0001); however, findings did not differ on this outcome between the 2019 and 2020 groups.
• CGM by patients with noncommercial insurance jumped from 24.5% in 2019 to 35.7% in 2020 (P = .0001) vs this outcome holding steady in commercially insured patients (61.8% and 61.4%, respectively).
• Strong correlations were seen between CGM percent time in range and A1C (R² = 0.49; P < .0001), and this was lower overall for Black (­–7.60; P < .0001) and Hispanic (­–2.96; P = .03) patients.
• PHQ-9 scores did not change significantly among those screened—female gender was the only influence seen for higher scores (P < .0001)—although the proportion of patients screened fell from 58.5% in 2019 to 41.5% in 2020 (P < .0001).

“In our large urban hospital setting, the COVID pandemic had no effect on glycemic control,” the authors concluded. “Rapid adoption of telemedicine, improved access to CGM and, perhaps, increased parental oversight of diabetes care likely helped maintain glycemic control and hospitalization frequencies at prepandemic levels.”

Generalization of their findings, however, may be limited because the patients in their analysis came from just 1 medical center and lived in urban areas, and similar results may not be seen among rural populations with lack of reliable access to internet and cellular phone connectivity. In addition, they used insurance status as a stand-in for socioeconomic status.

Reference

Choudhary A, Adhikari S, White PC. Impact of the COVID-19 pandemic on management of children and adolescents with type 1 diabetes. BMC Pediatr. Published online March 10, 2022. doi:10.1186/s12887-022-03189-2