Lessons from Continuous glucose monitoring during lockdown by Covid-19

t is known that in recent months health systems have suffered one of the most important pandemics in our history. This situation, apart from the personal drama of many of our patients, has meant a change in the healthcare paradigm. In the world of endocrinology and especially in diabetes, we have had to reinvent ourselves to continue offering quality care to our patients with DM1. Continuous monitoring systems and the ability to share glycemic control data has been a great help. In Asturias, as in the rest of Spain, progress is being made day by day to finance this type of system (Free style libre, FSL)) for all our patients with DM1.

Glycemic control data of patients with DM1 during the weeks of confinement have recently been published in the journal Diabetes Care (Blood Glucose Control During Lockdown for COVID-19: CGM Metrics in Italian Adults With Type 1 Diabetes; Diabetes Care 2020 Aug; 43 ( 8): e88-e89.https: //doi.org/10.2337/dc20-1127). In this study, an increase in the time in range (TIR) ​​is observed at the expense of a reduction in the hypoglycemic time (TBR), being more marked in patients using multiple doses of insulin. They also conducted surveys on diet, sleep and eating habits and observed a reduction in physical activity and a more stable meal schedule. As curious data, they highlight that the subgroup that increased their sleep hours are one of those that improved glycemic control the most.

In our center, Dr. Alonso, Dr. Rodríguez Escobedo and Dr. Martínez Tamés, retrospectively studied the FSL data during the lockdown, comparing them with data prior to the state of alarm. In this sense, they observed better glycemic control reflected in an increase in TIR at the expense of a decrease in hyperglycemic time with a consequent reduction in GMI (glucose management indicator). These data will be presented at the next Spanish Endocrinology Society Annual meeting

These surprising data demonstrate the importance of lifestyle measures in glycemic control. A controlled schedule, an adjustment of the diet and physical exercise plan outside the chaotic rhythm and stress of our day to day, have undoubtedly been key elements. This places, if possible, more emphasis on the need to intensify diabetes education as a firm commitment to self-control in our patients.

Therefore, it is not all bad news in the Covid-19 pandemic. The need for self-care and following diet and programmed exercise are 2 fundamental pillars in the treatment of DM1. Let’s continue encouraging our patients and our managers to fight for more and better diabetes education

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