How Did Elderly T2D Patients Cope With the Quebec Covid-19 Lockdown

The Canadian city most affected by the first wave of the Covid-19 (CV19) pandemic was Montreal. Montreal was in lockdown (LD) from Mar 13- Jun 15, 2020. The elderly, diabetics, and the economically disadvantaged are among the groups most at risk of CV19 and the psychosocial effects of LD. We sought to ascertain the effect of the LD on the wellbeing of lower income elderly T2D pts. As we felt it unethical to do non-essential testing during a pandemic we relied on clinically available HbA1c’s as surrogates for metabolic wellbeing. Most HbA1c‘s used reflect a high (r=0.91) correlation with 3 month values for the time periods of interest. The study group was composed of 38 mostly elderly T2D pts. All pts lived alone or with similarly aged spouses in non-institutional settings in a lower middle class neighborhood of Montreal. None had organized domestic help from family or the community. None had documented acute medical episodes or medication changes between Jan and Sept 2020. None have conditions known to render HbA1c non reliable. Pts were interviewed by telephone to assess their overall coping with the LD. In particular they were questioned about medical issues, difficulties obtaining medications +/- groceries and psychological or social stress. HbA1c values between Jan 1 - Mar 15, 2020 and after Aug 25, 2020 (non LD values) and between Apr 20 - Aug 15, 2020 (LD values) were recorded. Differences in the recorded non LD and LD HbA1c’s were compared and analyzed for the group as a whole, by gender, and by insulin use. There were 38 pts, 22 M 56–77 yrs (mean 72.1) and 16 F 41–90 yrs (mean 75.2), 89.5% (34/38) were > 65 yrs. Ten M and 9 F were on insulin. No pt reported severe hypoglycemia or weight fluctuations. All claimed to be following public health guidelines. There were no significant differences (d) between the mean HbA1c’s non LD compared to LD neither for the entire group (d= 0.2), M (d=0.2), F (d=0.2), insulin treated pts (d=0.3) nor those not treated with insulin (d=0.0). There were no overt medical decompensations. No pt reported having been unable to access medications or groceries. No pt reported significant psychological distress or feelings of isolation. None had been diagnosed with CV19. This largely geriatric T2D cohort did not report any overt deleterious effects from the LD. There were no significant differences in HbA1c non LD compared to LD. It is not possible to determine how effective the LD was in protecting these pts from CV19 other than to note that none had been diagnosed as having contracted the disease. As the 2nd wave of CV19 evolves, health care professionals will have the opportunity to study the effect of public health interventions, not only on controlling the spread of CV19, but also on the general wellbeing of different pt populations.