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      Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic

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          Abstract

          Background/Objective

          To minimize the wide spread of coronavirus disease (COVID-19) pandemic, Italy was placed in an almost complete lockdown state that forced people to “stay at home”. Aim of this study was to evaluate the effects of lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) followed through telemedicine.

          Subjects/Methods

          This observational study involved patients with T1D using the real-time continuous glucose monitoring (CGM) Dexcom G6 ®. Ambulatory glucose profile data from the 3-months before schools closure (November 26, 2019–February 23, 2020; T0) and from the 3-months of consecutive lockdown (February 24–May 18, 2020; T1) were compared.

          Results

          Sixty-two children and adolescents (11.1 ± 4.37 years, 50% males) with T1D (median time disease 3.67 years) were enrolled in the study. Insulin total daily dose was unchanged, while time spent on physical activities was decreased (p<0.0001). Despite the lack of statistical significance, median value of the glucose management indicator decreased from 7.4% to 7.25%. Glucose standard deviation (p<0.0001) and coefficient of variation (p=0.001) improved across the study. Median time in range increased from 60.5% to 63.5% (p=0.008), time above range decreased from 37.3% to 34.1% (p=0.048), and time below range decreased from 1.85% to 1.45% (p=0.001).

          Conclusions

          Overall, in our children and adolescents with T1D glycemic control improved during lockdown. Despite patients were confined to their homes and limited to exercise, our data suggest that the use of real-time CGM, the continuous parental management, and the telemedicine can display beneficial effects on T1D care.

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          Most cited references60

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
            • Record: found
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            Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China

            To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China.
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              • Article: not found

              2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2020

              (2019)
              The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee (https://doi.org/10.2337/dc20-SPPC), a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

                Author and article information

                Contributors
                Journal
                Front Endocrinol (Lausanne)
                Front Endocrinol (Lausanne)
                Front. Endocrinol.
                Frontiers in Endocrinology
                Frontiers Media S.A.
                1664-2392
                07 December 2020
                2020
                07 December 2020
                : 11
                : 595735
                Affiliations
                [1] 1 Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia , Modena, Italy
                [2] 2 Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia , Modena, Italy
                [3] 3 Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic , Modena, Italy
                [4] 4 Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria Policlinic , Modena, Italy
                Author notes

                Edited by: Gaetano Santulli, Columbia University, United States

                Reviewed by: Gian Luigi Marseglia, Fondazione Ospedale San Matteo (IRCCS), Italy; Nebojsa Lalic, University of Belgrade, Serbia

                *Correspondence: Barbara Predieri, barbara.predieri@ 123456unimore.it

                †ORCID: Barbara Predieri, orcid.org/0000-0002-3302-6886; Lorenzo Iughetti, orcid.org/0000-0003-0370-7872

                This article was submitted to Clinical Diabetes, a section of the journal Frontiers in Endocrinology

                Article
                10.3389/fendo.2020.595735
                7793913
                33424771
                b5c11f37-1654-40d0-9417-0549a503635d
                Copyright © 2020 Predieri, Leo, Candia, Lucaccioni, Madeo, Pugliese, Vivaccia, Bruzzi and Iughetti

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 17 August 2020
                : 11 November 2020
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 68, Pages: 10, Words: 5618
                Categories
                Endocrinology
                Original Research

                Endocrinology & Diabetes
                covid-19,telemedicine—utilization,continuous glucose monitoring system,glycemic control,type 1 diabetes,children and adolescents

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