Real-time CGM (rtCGM) during the COVID-19 Pandemic and its Impact on Time in Range.

TLDR: In this article, the authors examined data from 65,067 US-based users of the G6 rtCGM System (Dexcom, Inc., San Diego, CA) who had uploaded data before and during the COVID-19 pandemic.

Abstract: BACKGROUND: The COVID-19 pandemic disrupted the lives of people with diabetes. Use of real-time continuous glucose monitoring (rtCGM) helped manage diabetes effectively. Some of these disruptions may be reflected in population-scale changes to metrics of glycemic control, such as time in range (TIR). METHODS: We examined data from 65,067 US-based users of the G6 rtCGM System (Dexcom, Inc., San Diego, CA) who had uploaded data before and during the COVID-19 pandemic. Users associated with three counties that included the cities of Los Angeles, Chicago, and New York or with five regions designated by the Centers for Disease Control and Prevention (CDC) were compared. Public data were used to associate regions with pre-pandemic and intra-pandemic glycemic parameters, COVID-19 mortality, and median household income. RESULTS: Compared to an 8-week pre-pandemic interval before stay-at-home orders (06Jan2020 to 01Mar2020), overall mean (SD) TIR improved from 59.0 (20.1)% to 61.0 (20.4)% during the early pandemic period (20Apr2020 to 14Jun2020, p<0.001). TIR improvements were noted in all three counties and in all five CDC-designated regions. Higher COVID-19 mortality was associated with higher proportions of individuals experiencing TIR improvements of ≥5 percentage points. Users in economically wealthier zip codes had higher pre- and intra-pandemic TIR values and greater relative improvements in TIR. TIR and pandemic-related improvements in TIR varied across CDC-designated regions. CONCLUSIONS: Population-level rtCGM data may be used to monitor changes in glycemic control with temporal and geographic specificity. The COVID-19 pandemic is associated with improvements in TIR, which were not evenly distributed across the US.