Impact of Isolation during the COVID-19 Pandemic on the Care of Older Adults with Type 1 Diabetes: A Qualitative Study

Background: Older adults with type 1 diabetes (T1D) face unique challenges, especially when their support structure is disrupted, as happened during the Covid-19 lockdown. We evaluated the clinical and psychological impact of this imposed isolation on the older population with T1D. Methods: We conducted semi-structured interviews with older adults with T1D who were part of an ongoing study, which was paused from March - August 2020. The interviews were performed between May - August 2020, and were transcribed, coded, and analyzed using content analysis to derive theme. A multidisciplinary team of 12 individuals coded the interviews to identify the themes and included geriatricians, endocrinologists, a nurse educator, infomaticists, an economist, a methodologist, and research assistants. Results: We have analyzed 12/35 interviews at this time; mean age 74±4 years, 50% female, 92% non-Hispanic white, mean duration of diabetes 37±18 years, and A1C 7.3±0.7%. Three main themes have emerged. The challenges related to diabetes care included fear of hypoglycemia, interruption in supply chain related to diabetes technology (insulin pump and continuous glucose monitoring (CGM) supplies), use of telehealth, diabetes-related distress, and adapting to new routines in self-care (diet and exercise). Challenges related to the Covid-19 pandemic included fear of getting Covid-19 infection, and a lack of reliable information on pandemic. The challenges related to psychological well-being included a feeling of isolation, loneliness, inability to spend time with family and friends, lack of in-person communication, and lack of recreational activity. Conclusion: The results of this qualitative study help to understand critical areas of need when social support structures are unavailable to older adults with T1D. Our results will help develop intervention strategies to overcome barriers in maintaining support for this vulnerable population. Disclosure M. Munshi: Consultant; Self; Sanofi. S. Neuwahl: None. S. Cummings: None. S. L. Brown: Stock/Shareholder; Self; Pfizer Inc., Siemens Corporation. K. Weinger: None. E. Toschi: Consultant; Self; Medtronic. C. Slyne: None. K. Sifre: None. D. J. Davis: None. R. Dewar: None. S. M. Sy: None. A. Atakov-castillo: None. A. Michals: None. S. N. Haque: None. Funding National Institutes of Health (1DP3DK112214-01)