Article Text

Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic
  1. Merel M Ruissen1,
  2. Hannah Regeer1,
  3. Cyril P Landstra1,
  4. Marielle Schroijen1,
  5. Ingrid Jazet1,
  6. Michiel F Nijhoff1,
  7. Hanno Pijl1,
  8. Bart E P B Ballieux2,
  9. Olaf Dekkers1,3,
  10. Sasja D Huisman1,
  11. Eelco J P de Koning1
  1. 1Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  2. 2Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  3. 3Department of Epidemiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  1. Correspondence to Professor Eelco J P de Koning; E.J.P.de_Koning{at}


Introduction Lockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes.

Research design and methods We performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown.

Results In total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: −0.39% (−4.3 mmol/mol) (p<0.0001 and type 2 diabetes: −0.62% (−6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001).

Conclusions An increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.

  • diabetes mellitus
  • type 1
  • type 2
  • COVID-19

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  • Contributors MMR, HR, SDH and EJPdK designed the study and developed the methodology. MMR, HR and CPL coordinated the field work. MMR analyzed the data, wrote the manuscript and interpreted the results. HR, SDH and EJPdK reviewed the analysis, interpretations and manuscript and did the final review. CPL, MS, IJ, MFN, HP, BEPBB and OD reviewed the analysis and manuscript. MMR is the guarantor of this work and, as such, had access to all data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Medical Ethics Committee of Leiden, Den-Haag, Delft under the Medical Research Involving Human Subjects Act (WMO) prior to the start of the study (NL73778.058.20).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available on reasonable request. The data used in this article can be requested at the Leiden University Medical Center.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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