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this might be responsible for the improvement in HbA1c levels that were observed in June 2020. In addition, government, social demands, or anxiety and stress caused by the pandemic could have also led to behavioral changes9, 10). However, one study has reported that the use of lockdowns can have adverse effects on health indicators11). Thus, anxiety and stress associated with COVID-19 could have led to a worsening of the diabetes management in some Japanese patients.There were several limitations for the present study. First, this study is based on data from only one medical institution. Since this facility is a university hospital located in a metropolitan area in Japan, this could have led to bias in the subject selection. A larger number of medical institutions will need to be included in order to obtain more representative results. Second, we did not directly observe the activity of the individual subjects. Thus, changes in the behaviors of diabetic patients after activity restrictions remain unclear. In order to clarify what kind of behavioral changes might have potentially occurred in these diabetic patients, a direct questionnaire survey should have been utilized. In addition, this study does not describe the background of diabetic patients. Backgrounds such as diabetes type, age, gender and complica‑tions are also associated with lifestyle habits, and thus, patient background information will be needed for future studies. Finally, the results reported in the current study only present the short-term changes that occurred during the diabetes management. In Japan, the declaration of the first state of emergency was from April 7, 2020 until May 25, 2020. Thus, since June of 2020, the Japanese social activity level appears to have recovered2). Even so, continuation of the COVID-19 pandemic has resulted in various ongoing social changes. Therefore, the long-term impact of these changes on both the social activity and the social structure due to the COVID-19 pandemic in diabetes patients remains unknown. Long-term observational studies of diabetes management will need to be undertaken in the future.Results of the present observational study did not demonstrate there was a sustained increase in patients with worsening diabetes management during the short period of social activity restriction that was implemented to combat the COVID-19 336pandemic. However, the ongoing COVID-19 pandemic continues to be responsible for various social changes. In order to clarify the impact of the COVID-19 pandemic social changes on diabetes management, larger scale observational studies conducted over a longer period of time, with a wider variety of information collected will need to be undertaken.Not applicable.The Center for Promotion of Data Science was funded by 4DIN Ltd. The funding for this study was provided by 4DIN Ltd. The funding source played an important role in the preparation of the data for this study.TK: Conceptualization, Methodology, Software, Formal Analysis, Writing – Original Draft. KF: Conceptualization, Methodology, Data Curation, Formal Analysis, Investigation, Visualization, Writing – Original Draft, Project Administration. NY: Methodology, Formal Analysis, Validation. NF: Software, Data Curation, Validation. AT: Software, Data Curation. TN: Writing – Review & Editing, Supervision. RK: Writing – Review & Editing, Supervision. HW: Writing – Review & Editing, SupervisionThe following authors have financial relation‑ships to disclose.NF is an employee of 4DIN Ltd.AT is an employee of 4DIN Ltd., and has a lead‑ership role in a private company.None of the other authors have any financial rela‑tionships to disclose. 1) Pai LW, Li TC, Hwu YJ, Chang SC, Chen LL, Chang PY: The effectiveness of regular leisure-time physical activities on long-term glycemic control in people with type 2 diabetes: A systematic review and meta-anal‑ysis. Diabetes Res Clin Pract, 2016; 113: 77-85. 2) Apple “COVID‑19 - Mobility Trends Reports” https://covid19.apple.com/mobility. Accessed 19 February 2021. 3) Stratton IM, Adler AI, Neil HA, et al: Association of glycaemia with macrovascular and microvascular AcknowledgementsFundingAuthors’ contributionsConflicts of interest statementReferences