Diabetes Metab J.  2022 Mar;46(2):260-272. 10.4093/dmj.2021.0125.

Impact of COVID-19 Lockdown on the Metabolic Control Parameters in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis

• Wafa IA
• Pratama NR
• Sofia NF
• Anastasia ES
• Konstantin T
• Wijaya MA
• Wiyono MR
• Djuari L
• Novida H

• KMID: 2527719
• DOI: http://doi.org/10.4093/dmj.2021.0125

Abstract

Background
Abrupt implementation of lockdowns during the coronavirus disease 2019 (COVID-19) pandemic affected the management of diabetes mellitus in patients worldwide. Limited access to health facilities and lifestyle changes potentially affected metabolic parameters in patients at risk. We conducted a meta-analysis to determine any differences in the control of metabolic parameters in patients with diabetes, before and during lockdown.
Methods
We performed searches of five databases. Meta-analyses were carried out using random- or fixed-effect approaches to glycaemic control parameters as the primary outcome: glycosylated hemoglobin (HbA1c), random blood glucose (RBG), fasting blood glucose (FBG), time-in-range (TIR), time-above-range (TAR), time-below-range (TBR). Mean difference (MD), confidence interval (CI), and P value were calculated. Lipid profile was a secondary outcome and is presented as a descriptive analysis.
Results
Twenty-one studies enrolling a total of 3,992 patients with type 1 or type 2 diabetes mellitus (T1DM or T2DM) were included in the study. Patients with T1DM showed a significant improvement of TIR and TAR (MD=3.52% [95% CI, 0.29 to 6.74], I²=76%, P=0.03; MD=–3.36% [95% CI, –6.48 to –0.25], I²=75%, P=0.03), while FBG among patients with T2DM significantly worsened (MD=3.47 mg/dL [95% CI, 1.22 to 5.73], I²=0%, P<0.01). No significant difference was found in HbA1c, RBG, and TBR. Use of continuous glucose monitoring in T1DM facilitated good glycaemic control. Significant deterioration of lipid parameters during lockdown, particularly triglyceride, was observed.
Conclusion
Implementation of lockdowns during the COVID-19 pandemic did not worsen glycaemic control in patients with diabetes. Other metabolic parameters improved during lockdown, though lipid parameters, particularly triglyceride, worsened.

Keyword

COVID-19; Diabetes mellitus; Meta-analysis; Systematic review; Triglycerides

Figure

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  Fig. 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study selection process [9].

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  Fig. 2 Forest plots of meta-analysis for fasting blood glucose. SD, standard deviation; IV, inverse variance; CI, confidence interval.

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  Fig. 3 Forest plots of meta-analysis for time-in-range. SD, standard deviation; IV, inverse variance; CI, confidence interval.

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  Fig. 4 Forest plots of meta-analysis for time-above-range. SD, standard deviation; IV, inverse variance; CI, confidence interval.

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