Impact of the COVID-19 lockdown on behavior, stress, anxiety and glycemic control in patients with beta cell transplantation
Cyril P. Landstra1,2, Merel M. Ruissen1, Hannah Regeer1, Michiel F. Nijhoff1,2, Bart E.P.B. Ballieux3, Paul J.M. van der Boog2, Aiko P.J. de Vries2, Sasja D. Huisman1, Eelco J.P. de Koning1,2.
1Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands; 2Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands; 3Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
Introduction: Patients with severely complicated type 1 diabetes (T1D) who receive β-cell transplantation (Tx) have multiple risk factors for a severe course of coronavirus disease, including the use of immunosuppression (IS). Lockdown strategies implemented due to the COVID-19 pandemic are known to impact both mental and physical health, but this impact is expected to be even greater in patients at high risk for a severe course of COVID-19. We therefore aimed to investigate the behavioral, mental and physical implications of the nationwide lockdown in islet and pancreas transplant recipients (referred to in this abstract as β-cell Tx).
Methods: In order to study the effect of the lockdown on glycemic control, all patients with T1D and an islet transplantation or pancreas transplantation with non-optimal graft function according to the Igls criteria using IS were eligible. As a control group, patients with T1D without IS were included. Lockdown behavior and self-reported changes in anxiety, stress, physical activity, weight, and glycemic control were assessed using questionnaires. HbA1c and continuous glucose monitoring (CGM) metrics during lockdown were compared to measurements before lockdown.
Results: Islet and pancreas (β-cell) Tx recipients (n = 51, age 55 (48 – 59) years, BMI 23.3 (20.9 – 27.4) kg/m2, diabetes duration 42 (34 – 48) years) adhered more stringently to lockdown measures compared to patients with T1D alone (n = 272, age 53 (37 – 62) years, BMI 25.2 (23.0 – 28.0) kg/m2, diabetes duration 27 (15 – 39) years). In β-cell Tx recipients as compared to T1D, 52.1% vs 18.3% (p <0.001) reported not going out for groceries and 45.8% vs 14.0% (p <0.001) reported not leaving the house at all. Fear of coronavirus infection was higher in β-cell Tx recipients (VAS 5.0 (3.0 – 7.0) vs 3.0 (2.0 – 5.0), p=0.004) and glycemic control worsened during lockdown as assessed by HbA1c (ΔHbA1c +1.67 ± 8.74 vs -1.72 ± 6.15 mmol/mol, p=0.006) as well as CGM (Δ time in range β-cell Tx -4.5% (-6.0% – 1.5%) vs T1D 3.0% (-2.0% – 6.0%), p=0.038; Δ time above range β-cell Tx 5.5% (-0.5% – 7.5%) vs T1D -3.0% (-7.5% – 3.0%), p=0.025). Among β-cell Tx recipients, 29.2% self-reported more difficulty with glycemic control, 26.8% increased insulin use, 40.0% less physical activity, 41.7% weight gain, 29.2% increased anxiety and 33.3% increased stress since the start of lockdown. Having had a β-cell Tx was the most important predictor of not leaving the house during the COVID-19 lockdown.
Conclusions: The COVID-19 pandemic and subsequent lockdown add additional fear of infection, deterioration of glycemic control and more stringent social isolation behavior when patients with T1D also have an islet or pancreas transplant. These patients undertake less physical activity and experience more weight gain, stress and anxiety. Health care professionals should be aware of these behavioral, mental and physical implications to be able to provide extra support.