UMMS Affiliation

Division of Endocrinology, Department of Pediatrics; Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Nutritional and Metabolic Diseases | Pediatrics


Importance: There is no consensus on the impact of the 2020 COVID-19 pandemic lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) in the US.

Aim: To determine the impact of the pandemic lockdown of March 15th through July 6(th), 2020 on glycemic control after controlling for confounders.

Subjects and Methods: An observational study of 110 subjects of mean age 14.8 +/- 4.9 years(y), [male 15.4 +/- 4.0y, (n=57); female 14.1 +/- 3.8y, (n=53), p=0.07] with T1D of 6.31 +/- 4.3y (95% CI 1.0-19.7y). Data were collected at 1-4 months before the lockdown and 1-4 months following the lifting of the lockdown at their first post-lockdown clinic visit.

Results: There was no significant change in A1c between the pre- and post-pandemic lockdown periods, 0.18 +/- 1.2%, (95% CI -0.05 to 0.41), p=0.13. There were equally no significant differences in A1c between the male and female subjects, -0.16 +/- 1.2 vs -0.19 +/- 1.2%, p=0.8; insulin pump users and non-pump users, -0.25 +/- 1.0 vs -0.12 +/- 1.4%, p=0.5; and pubertal vs prepubertal subjects, 0.18 +/- 1.3 vs -0.11 +/- 0.3%, p=0.6. The significant predictors of decrease in A1c were pre-lockdown A1c (p < .0001) and the use of CGM (p=0.019). The CGM users had significant reductions in point-of-care A1c (0.4 +/- 0.6%, p=0.0012), the CGM-estimated A1c (p=0.0076), mean glucose concentration (p=0.022), a significant increase in sensor usage (p=0.012), with no change in total daily dose of insulin (TDDI). The non-CGM users had significantly increased TDDI (p < 0.0001) but no change in HbA1c, 0.06 +/- 1.8%, p=0.86.

Conclusions: There was no change in glycemic control during the pandemic lockdown of 2020 in US children.


COVID-19 pandemic, adolescents, children, hemoglobin A1c, type 1 diabetes

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Copyright © 2021 Nwosu, Al-Halbouni, Parajuli, Jasmin, Zitek-Morrison and Barton. 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.

DOI of Published Version



Nwosu BU, Al-Halbouni L, Parajuli S, Jasmin G, Zitek-Morrison E, Barton BA. COVID-19 Pandemic and Pediatric Type 1 Diabetes: No Significant Change in Glycemic Control During The Pandemic Lockdown of 2020. Front Endocrinol (Lausanne). 2021 Aug 10;12:703905. doi: 10.3389/fendo.2021.703905. PMID: 34447352; PMCID: PMC8383280. Link to article on publisher's site

Journal/Book/Conference Title

Frontiers in endocrinology

PubMed ID


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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.