Israel Study: Kids With T1D Held Steady During COVID Lockdown

A study from Israel offers reassuring — and cautionary — findings for American families managing type 1 diabetes (T1D) in children: during the COVID-19 lockdown, most kids kept their blood sugar surprisingly stable, but younger children from lower-income households faced the greatest risk of worsening control.

What the Researchers Did

Scientists at the Pediatric Endocrinology and Diabetes Unit, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center studied 102 children with T1D (average age 11.2 years) who were using Dexcom G5 continuous glucose monitors (CGM). Crucially, the research team reviewed CGM data remotely — with no in-person clinic visits — mirroring the telehealth reality many US families experienced during the pandemic. Researchers compared key CGM measurements before and during Israel's national lockdown.

Key Findings in Plain English

The central measure tracked was Time in Range (TIR) — the percentage of the day a child's blood sugar stays between 70–180 mg/dL, the standard target range used in both Israel and the United States.

• Overall blood sugar control held steady. Average TIR before lockdown was 60.9%, and it barely budged during lockdown (an average change of just +0.9%). The American Diabetes Association (ADA) recommends a TIR above 70% for most people with T1D, so there is room for improvement — but lockdown itself didn't make things worse for most kids.
• Pre-lockdown control predicted lockdown control. Children who were well-managed before COVID stayed well-managed during it (r = 0.855, P < 0.001). In other words, good habits carried through the crisis.
• Older children (10 and up) fared better. Teens and pre-teens were more likely to actually improve their TIR during lockdown — possibly because reduced school schedules created more predictable routines.
• Younger children (under 10) showed more blood sugar variability. This age group had a significantly higher coefficient of variation (CV) — a measure of how erratically blood sugar swings — both before and during lockdown. Lower socioeconomic status compounded this instability.

Why This Matters for US Patients

The United States faced its own waves of school closures, lockdowns, and disrupted routines during COVID-19 — and many American families are still navigating the aftermath. This Israeli research, conducted with widely available Dexcom technology used across the US, highlights several lessons directly applicable to American care:

• Remote CGM monitoring works. The diabetes team managed 102 patients without a single in-person visit, validating the telehealth model now expanding across US pediatric diabetes clinics.
• Social determinants matter. Younger children in lower-income households struggled most. US providers and policymakers should prioritize outreach, CGM access, and support resources for these families — especially during disruptions like holidays, summer break, or future public health emergencies.
• Routine is medicine. The stability seen in most children suggests that consistent daily structure — even a lockdown structure — can support glycemic control. US families can apply this by maintaining meal timing, sleep schedules, and activity routines during school breaks.
• Don't wait for the next crisis. Children who entered lockdown with poor control stayed poorly controlled. Now is the time to optimize TIR toward the ADA's 70%+ goal.

Original Study

Brener A, Mazor-Aronovitch K, Rachmiel M, et al. "Lessons learned from the continuous glucose monitoring metrics in pediatric patients with type 1 diabetes under COVID-19 lockdown." Acta Diabetologica. 2020. PMID: 33026497. DOI: 10.1007/s00592-020-01596-4