Type 1 Diabetes, Type 2 Diabetes
Conditions
Keywords
COVID-19 Pandemic, Type 1 Diabetes, Type 2 Diabetes, Beta Cell Transplantation, Social isolation, Glycemic control, Distress, COVID-19 Lockdown
Brief summary
Diabetes mellitus is a chronic disease characterized by the inability of the body to maintain normoglycemia. Treatment of diabetes relies mostly on diabetes self-management, requiring a large investment of time and energy on a daily basis. Psychological wellbeing, behavioral patterns and social context play a major role in diabetes self-management and glycemic control. Social isolation behavior (self-quarantining) may impact glycemic control by influencing daily routines, therapy adherence, physical activity, and self-measurement and eating behaviors. Therefore, a period of nationwide self-quarantine, such as during the lockdown issued during the COVID-19 outbreak in the Netherlands, may have a large effect on glycemic control in patients with diabetes. In this observational cross sectional study, we aim to assess the impact of long-term self-quarantine on glycemic control, diabetes self-management and distress in patients with type 1 and type 2 diabetes mellitus. A specific subgroup of patients with T1D are those with complicated diabetes who have received a pancreas or islet transplantation and use immunosuppression, having multiple risk factors for severe COVID-19. The impact of lockdown strategies on mental and physical health is expectedly even greater in patients at even higher risk for severe COVID-19. We therefore additionally investigated differences in behavioral, mental and physical implications of a nationwide lockdown on patients with type 1 diabetes with and without islet or pancreas transplantation. Measurements will be performed during the lockdown period. Patients will be asked to perform a fingerprick HbA1c measurement once, sent back to the LUMC by mail. Data from continuous or flash glucose monitoring devices will be collected according to standard clinical practice. Furthermore, patients will be asked to fill out an online questionnaire once on diabetes self-management behavior, well-being and distress, along with questions about health status, level of education, medication use, employment, social situation and the impact of self-quarantine on daily routines. In this questionnaire, we ask patients to compare certain aspects of their life (e.g. anxiety, stress, weight, physical activity, glycemic control) at the time of the lockdown to before the lockdown. Data on demographics, type of diabetes, weight, BMI and HbA1c prior to the COVID-19 outbreak will be derived from the patient's electronic health file.
Interventions
OTHERNo interventions, observational study
Not applicable, no interventions, observational study
Sponsors
Leiden University Medical Center
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* Age ≥ 18 years * Diagnosed with type 1 or type 2 diabetes * Ability to perform fingerpricks * Sufficient comprehension of the Dutch language * Ability to fill out online questionnaires
Exclusion criteria
* Pregnancy * Newly diagnosed malignancy, with the exclusion of non-melanoma skin cancer, in the previous 6 months * Chemotherapy or immunotherapy for malignancy * Admission to hospital or rehabilitation center
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Glycemic control | HbA1c measurement during lockdown (8 - 11 weeks after the start of the lockdown (March 15th 2020)) compared to last measurement before lockdown (last known measurement before March 15th 2020) | HbA1c (mmol/mol Hb) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Stress | PSS During lockdown + self-comparison change to before lockdown (questionnaire filled in between 8 - 11 weeks after the start of the lockdown (March 15th 2020)) | Perceived Stress Scale (PSS) + self-reported change in stress during lockdown compared to before lockdown |
| Anxiety | Questionnaire filled in between 8 - 11 weeks after the start of the lockdown (March 15th 2020)) | Self-reported change in anxiety during lockdown compared to before lockdown |
| Weight | Questionnaire filled in between 8 - 11 weeks after the start of the lockdown (March 15th 2020)) | Self-reported weight change during lockdown compared to before lockdown |
| Glycemic control | 2 week period during lockdown compared to 2 week period before lockdown | Continuous Glucose Measurement parameters (time in range, time above range, time below range) |
| Glycemic control and insulin requirements | Questionnaire filled in between 8 - 11 weeks after the start of the lockdown (March 15th 2020)) | Self-reported change in difficulty with glycemic control and insulin requirements during lockdown compared to before lockdown |
| Social isolation behaviour | Questionnaire filled in between 8 - 11 weeks after the start of the lockdown (March 15th 2020)) | Self-reported social isolation behaviour during lockdown |
| Fear of COVID-19 infection | Questionnaire filled in between 8 - 11 weeks after the start of the lockdown (March 15th 2020)) | Fear of contracting COVID-19, scored using a Visual Analogue Scale (1-10), during lockdown |
| Physical activity | Questionnaire filled in between 8 - 11 weeks after the start of the lockdown (March 15th 2020)) | Self-reported change in physical activity during lockdown compared to before lockdown |
Countries
Netherlands
Outcome results
None listed