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Impact of COVID-19 Lockdown on the Metabolic Control Parameters in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis
Ifan Ali Wafa, Nando Reza Pratama, Nurizzah Farahiyah Sofia, Elsha Stephanie Anastasia, Tiffany Konstantin, Maharani Ayuputeri Wijaya, M. Rifqi Wiyono, Lilik Djuari, Hermina Novida
Diabetes Metab J. 2022;46(2):260-272.   Published online March 8, 2022
  • 6,397 View
  • 277 Download
  • 11 Web of Science
  • 11 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
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.
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.
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.
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.


Citations to this article as recorded by  
  • Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol
    Samira Barbara Jabakhanji, Oluwabunmi Ogungbe, Sonia Y Angell, Lawrence Appel, David Byrne, Roopa Mehta, John McCaffrey, Lori Rosman, Edward W Gregg, Kunihiro Matsushita
    BMJ Open.2024; 14(1): e074443.     CrossRef
  • Influence of the COVID-19 pandemic on the achievement of guideline targets for HbA1c, blood pressure, and LDL cholesterol in people with diabetes in Japan
    Shingo Kuwajima, Takahito Itoh, Tatsuya Sato, Shoya Ino, Satoru Shibata, Kouhei Ohno, Hiroyuki Hotta, Tomoaki Matsumoto, Hitoshi Ooiwa, Hirofumi Kubo, Takayuki Miki
    Diabetology International.2024;[Epub]     CrossRef
  • Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico
    Devany Paola Morales-Rodriguez, Arnulfo González-Cantú, Arnulfo Garza-Silva, Andrea Rivera-Cavazos, Iván Francisco Fernández-Chau, Andrea Belinda Cepeda-Medina, Miguel Angel Sanz-Sánchez, Gerardo Francisco del Rio-Parra, María Angelina Torres-Fuentes, Mig
    Diabetology & Metabolic Syndrome.2024;[Epub]     CrossRef
  • Glycemic Control in Type 1 Diabetes Mellitus and COVID-19: What We Learned From the Lockdown Experience
    Catarina Almeida, André Ferreira, Daniela Duarte, Ana Filipa Viegas, André Santos, Alexandra Vaz, Edite Nascimento
    Cureus.2023;[Epub]     CrossRef
  • Changes in body weight and glycemic control in association with COVID-19 Shutdown among 23,000 adults with type 2 diabetes
    Emily Panza, Kevin E. Kip, Kripa Venkatakrishnan, Oscar C. Marroquin, Rena R. Wing
    Acta Diabetologica.2023; 60(6): 787.     CrossRef
  • The Impact of a Lockdown for the COVID-19 Pandemic on Seasonal HbA1c Variation in Patients with Type 2 Diabetes
    Yu-Cheng Cheng, Yu-Hsuan Li, Hsiu-Chen Liu, Chiann-Yi Hsu, Wan-Jen Chang, I-Te Lee, Chin-Li Lu
    Life.2023; 13(3): 763.     CrossRef
  • The Impact of Partial Lockdown During COVID-19 Pandemic on Metabolic Control in People with Type 2 Diabetes Mellitus
    Ayşe Zülal TOKAÇ, Tuğde Buse UĞUR, Buse Ecem KURUGÖL, Sevilay ALİGÜLÜ, Osman HAYRAN
    Journal of Biotechnology and Strategic Health Research.2023; 7(1): 67.     CrossRef
  • Retrospective Study on the Impact of COVID-19 Lockdown on Patients with Type 2 Diabetes in Northern Taiwan
    Hsuan Huang, Hsiao-Ling Su, Chih-Hsung Huang, Yi-Hsin Lin
    Diabetes, Metabolic Syndrome and Obesity.2023; Volume 16: 2539.     CrossRef
  • RIPK1 and RIPK3 inhibitors: potential weapons against inflammation to treat diabetic complications
    Dan Ke, Zhen Zhang, Jieting Liu, Peijian Chen, Yucen Dai, Xinhai Sun, Yanhui Chu, Luxin Li
    Frontiers in Immunology.2023;[Epub]     CrossRef
  • “Does Physical Exercise Promote Health Benefits for Diabetic Patients during the COVID-19 Pandemic?”: A Systematic Review
    Erivaldo de Souza, Daniela Meneses-Santos, Josué Cruz Santos, Felipe J. Aidar, Carla Roberta de Oliveira Carvalho, Jymmys Lopes dos Santos, Anderson Carlos Marçal
    Sports.2023; 11(10): 192.     CrossRef
  • Impact of National Lockdown From COVID-19 Pandemic in Patients With Type 2 Diabetes: An Observational Study
    Nuntakorn Thongtang, Niracha Chanwimol, Lukana Preechasuk, Varisara Boonyuang, Pinyo Rattanaumpawan, Supawadee Likitmaskul, Apiradee Sriwijitkamol
    Asia Pacific Journal of Public Health.2022; 34(6-7): 708.     CrossRef
Cardiovascular Risk/Epidemiology
Article image
Appraisal of Guidelines for the Management of Blood Pressure in Patients with Diabetes Mellitus: The Consensuses, Controversies and Gaps
Menghui Liu, Shaozhao Zhang, Xiaohong Chen, Yue Guo, Xiangbin Zhong, Zhenyu Xiong, Yifen Lin, Huimin Zhou, Yiquan Huang, Zhengzhipeng Zhang, Lichun Wang, Xiaodong Zhuang, Xinxue Liao
Diabetes Metab J. 2021;45(5):753-764.   Published online April 23, 2021
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  • 145 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations.
Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients.
The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.
Clinical Diabetes & Therapeutics
Effectiveness of Exercise Intervention in Reducing Body Weight and Glycosylated Hemoglobin Levels in Patients with Type 2 Diabetes Mellitus in Korea: A Systematic Review and Meta-Analysis
Ji-Eun Jang, Yongin Cho, Byung Wan Lee, Ein-Soon Shin, Sun Hee Lee
Diabetes Metab J. 2019;43(3):302-318.   Published online November 19, 2018
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  • 98 Download
  • 13 Web of Science
  • 13 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   

This study aimed to assess the effectiveness of exercise intervention in reducing body weight and glycosylated hemoglobin (HbA1c) level in patients with type 2 diabetes mellitus (T2DM) in Korea.


Cochrane, PubMed, Embase, KoreaMed, KMbase, NDSL, KCI, RISS, and DBpia databases were used to search randomized controlled trials and controlled clinical trials that compared exercise with non-exercise intervention among patients with non-insulin-treated T2DM in Korea. The effectiveness of exercise intervention was estimated by the mean difference in body weight changes and HbA1c level. Weighted mean difference (WMD) with its corresponding 95% confidence interval (CI) was used as the effect size. The pooled mean differences of outcomes were calculated using a random-effects model.


We identified 7,692 studies through literature search and selected 23 articles (723 participants). Compared with the control group, exercise intervention (17 studies) was associated with a significant decline in HbA1c level (WMD, −0.58%; 95% CI, −0.89 to −0.27; I2=73%). Although no significant effectiveness on body weight was observed, eight aerobic training studies showed a significant reduction in body weight (WMD, −2.25 kg; 95% CI, −4.36 to −0.13; I2=17%) in the subgroup analysis.


Exercise significantly improves glycemic control; however, it does not significantly reduce body weight. Aerobic training can be beneficial for patients with non-insulin-treated T2DM in Korea.


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  • Effect of chronic High Intensity Interval Training on glycosylated haemoglobin in people with type 2 diabetes: a meta-analysis
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    Human Movement.2021; 24(1): 32.     CrossRef
  • Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Position Statement of the Fatty Liver Research Group of the Korean Diabetes Association
    Byung-Wan Lee, Yong-ho Lee, Cheol-Young Park, Eun-Jung Rhee, Won-Young Lee, Nan-Hee Kim, Kyung Mook Choi, Keun-Gyu Park, Yeon-Kyung Choi, Bong-Soo Cha, Dae Ho Lee
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    Mee Ock Gu
    Korean Journal of Adult Nursing.2019; 31(3): 235.     CrossRef
Targeting the Peroxisome Proliferator-Activated Receptor-γ to Counter the Inflammatory Milieu in Obesity
Cesar Corzo, Patrick R. Griffin
Diabetes Metab J. 2013;37(6):395-403.   Published online December 12, 2013
  • 3,989 View
  • 33 Download
  • 34 Crossref
AbstractAbstract PDFPubReader   

Adipose tissue, which was once viewed as a simple organ for storage of triglycerides, is now considered an important endocrine organ. Abnormal adipose tissue mass is associated with defects in endocrine and metabolic functions which are the underlying causes of the metabolic syndrome. Many adipokines, hormones secreted by adipose tissue, regulate cells from the immune system. Interestingly, most of these adipokines are proinflammatory mediators, which increase dramatically in the obese state and are believed to be involved in the pathogenesis of insulin resistance. Drugs that target peroxisome proliferator-activated receptor-γ have been shown to possess anti-inflammatory effects in animal models of diabetes. These findings, and the link between inflammation and the metabolic syndrome, will be reviewed here.


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Diabetes Epidemics in Korea: Reappraise Nationwide Survey of Diabetes "Diabetes in Korea 2007"
Ie Byung Park, Jaiyong Kim, Dae Jung Kim, Choon Hee Chung, Jee-Young Oh, Seok Won Park, Juneyoung Lee, Kyung Mook Choi, Kyung Wan Min, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Hwayoung Kim, Sunhee Lee, Im Bong Lee, Injeoung Choi, Sei Hyun Baik
Diabetes Metab J. 2013;37(4):233-239.   Published online August 14, 2013
  • 5,763 View
  • 60 Download
  • 62 Crossref
AbstractAbstract PDFPubReader   

There are many studies on the prevalence, clinical characteristics, and economic burden of diabetes across the past four decades in Korea. Nonetheless, there is a dearth of nationwide study regarding diabetes encompassing all age group. Eight years ago, the Committee on the Epidemiology of Diabetes Mellitus of Korean Diabetes Association collaborated with Health Insurance Review & Assessment Service to evaluate the status of diabetes care and characteristics in diabetic patients in Korea. In 2007, the collaborative task force team published a comprehensive survey titled "Diabetes in Korea 2007." In this review, we reappraise the diabetic epidemics from the joint report and suggest further studies that are needed to be investigated in the future.


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