Of the 455 individuals invited for the survey, 451 consented to participate. Among these, 280 participants (133 males) met the age-inclusion criteria and were included in the study. For a total of 97 T1D cases, an equal number of age and gender matched participants were randomly recruited in the control group. As such, a total of 194 responses was included in the final analysis. The mean age of the 194 participants was 18.9 (4.5) years. Data was collected from all over the country with maximum representation from Uttar Pradesh (63.4%) followed by Delhi (18.6%). The baseline socio-demographic characteristics of the participants is depicted in Table 1.
A total of 97 adolescents and young adults [49 males; mean age 18.8 (4.5) years, diagnosed with type 1 diabetes, mean duration of diabetes 8.0 (5.0) years; mean HBA1C 8.1 (1.5)%] completed the survey. Majority were on basal bolus regime (82.5%) followed by split mix regime (12.4%) and continuous subcutaneous insulin infusion (CSII; 5.2%).
Of the 194 participants, all had either heard or read about the COVID-19 pandemic. The prime source of information was television (72.2%) followed by search engines, such as Google (69.1%). Around 76.3% (n = 148) of the participants were satisfied with the available information; with almost all (92.2%) accessing information at least once daily.
Of the 97 cases, around 96.9 % (n = 94) had some information pertaining to the ways of COVID-19 transmission. Proportion of cases and controls who opted for different ways of transmission is shown in Fig.1a. A significant proportion (77.3%; n = 75) scored more than 50% in the transmission score (i.e., they knew about two or more ways of COVID-19 transmission). No difference in the mean transmission score % was noted between the cases and control groups (Mean rank 93.18 versus 101.82 ; p = 0.236).
All the subjects with T1D knew about at least one of the preventive measures against COVID-19. Proportion of cases and controls who opted for different preventive measures is shown in Fig.1b. A significant proportion (95.9%; n = 93) scored more than 50% in the preventive measures score (i.e., they knew about two or more preventive measures against COVID-19 infection). No significant difference in prevention score % was noted between the cases and control groups (Mean rank 96.38 versus 98.62 ; p = 0.619).
Around 96.9% of the cases (n = 94) had some knowledge regarding the symptoms of COVID-19. Proportion of cases and controls who opted for different presentations of COVID-19 is shown in Fig.1c. A considerable proportion of the participants 86.6% (n = 84) scored more than 50% in the COVID-19 symptoms score (i.e., they knew about three or more symptoms of COVID-19 infection). Around 11.3% (n = 11), reported to have experienced one or the other of the above symptoms over the last two weeks. A significant difference in presentation score % was noted between the two groups (Mean rank 89.44 versus 105.56 ; p = 0.04).
Nearly, half of all the cases 53.6% (n = 52), reported moderate stress (PSS score 15-24); low stress (PSS score 0-14) was perceived by 41.2% (n = 40) and severe stress (PSS score 25-40) was observed in 5.2% (n = 5); (Fig.2). There was no significant difference in the mean PSS score between cases and controls (Mean rank 101.06 versus 93.94 ; p = 0.374). A total of 80.4% (n = 78) of cases responded to the question regarding the various coping methods used to deal with stress. Nearly two-thirds of them, 74.4% (n = 58) opted for talking with friends and family members as a coping measure.
Notably, cases with higher PSS scores tracked pandemic-related updates with significantly lesser frequency than those with lower stress scores (mean rank 78.75; p = 0.01). A significant positive correlation was obtained between the PSS score and HBA1C level over the last 6 months (r= 0.276, p value = 0.015). No significant association with PSS score was observed for age, gender, level of satisfaction with the available information, education status, occupation, type of residence, source of information, presence of any symptom over the last 14 days, duration of diabetes or insulin regimen, as tabulated in Table 2.
Reduced frequency of monitoring of blood glucose was reported by 54.6% (n = 53) of all the cases. Based on the self-monitoring of blood glucose (SMBG) over the last one month; improved glycemic control was reported by 39.2% (n = 38), worsened glycemic control by 15.5% (n = 15) and nearly half of them, 45.3% (n = 44) reported no change. High PSS score was observed to be significantly associated with worsened glycemic control (mean rank 63.97 p = 0.012), Fig.3. Of the 81 cases who answered the question regarding the challenges faced during the current pandemic, around 54.3% (n = 44) reported inadequate physical activity and 51.9% (n = 42) admitted to difficulty in maintaining a healthy balanced diet.
A significant proportion of the cases (66.6%; n = 64) felt the need of easy availability of insulin and glucometer strips, online/telephonic consultations (63.54%; n = 61) and more information regarding T1D management during the current pandemic (52.6%; n = 51).