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Kim SY. Commentary on "New-onset diabetes in children during the COVID-19 Pandemic: an assessment of biomarkers and psychosocial risk factors at play in Mississippi". Ann Pediatr Endocrinol Metab 2024; 29:209-210. [PMID: 39231481 PMCID: PMC11374515 DOI: 10.6065/apem.24223091edi04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Affiliation(s)
- Se Young Kim
- Division of Pediatric Endocrinology, Department of Pediatrics, Bundang Jesaeng Hospital, Daejin Medical Center, Seongnam, Korea
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Stout J, Dixit N, Pasha S, Sukumaran A, Topaloglu AK, Armstrong MK, Garg P, Karlson C, Bates JT, Ansari MAY, Kamran F. New-onset diabetes in children during the COVID-19 Pandemic: an assessment of biomarkers and psychosocial risk factors at play in Mississippi. Ann Pediatr Endocrinol Metab 2024; 29:234-241. [PMID: 38853577 PMCID: PMC11374513 DOI: 10.6065/apem.2346182.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/12/2023] [Indexed: 06/11/2024] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has led to an association between COVID-19 and pediatric diabetes. Studies have indicated the increased likelihood of children with COVID-19 infection developing diabetes. Our objective was to assess not only the increase in pediatric diabetes at our hospital and identify possible risk factors, but also to correlate the psychosocial changes resulting from the pandemic with new-onset diabetes. METHODS We analyzed data from 58 children aged 1 to 18 years admitted to our hospital with new-onset diabetes between March 2020 and December 2021. The data included inflammatory biomarkers and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies (Abs), as well as the results of a lifestyle questionnaire. RESULTS The average number of hospital admissions per month for new-onset diabetes increased from 10 to 18 with the start of the pandemic. Of the 58 children in our analysis, 33% had positive SARS-CoV-2 IgG Ab, 31% had type 1 diabetes mellitus, and 62% had type 2 diabetes mellitus (T2DM). More than half (54%) were experiencing diabetic ketoacidosis. Those with T2DM were older, majority African American, had higher median body mass index (BMI) percentiles, and lower vitamin D levels. There were no significant correlations between any psychosocial risk factors and either diabetes type or SARS-CoV2 Ab status. CONCLUSION Despite the increased incidence of new-onset diabetes among children in Mississippi during the pandemic, this study was unable to demonstrate a significant correlation between COVID-19 infection and new-onset diabetes. The findings of this study highlighted the correlation between increased BMI and type 2 diabetes, underscoring the significant problems of obesity and diabetes in our study region. Further research is warranted.
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Affiliation(s)
- Josephine Stout
- Arkansas Children's Hospital, Little Rock, AR, USA
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Naznin Dixit
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Simeen Pasha
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Anju Sukumaran
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | | | - Padma Garg
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - John T Bates
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Fariha Kamran
- University of Mississippi Medical Center, Jackson, MS, USA
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Ahangar Davoodi M, Zamanian M, Balali B. Increased incidence of the type 1 diabetes and diabetic ketoacidosis severity in children during COVID-19 pandemic. Diabetol Metab Syndr 2024; 16:121. [PMID: 38822415 PMCID: PMC11141025 DOI: 10.1186/s13098-024-01357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/21/2024] [Indexed: 06/03/2024] Open
Abstract
AIM The effect of COVID-19 on the occurrence of type 1 diabetes and ketoacidosis in children and adolescent. METHODS In this descriptive-analytical cross-sectional study, the records of all children and adolescents hospitalized due to type1 diabetes for two years ago and during the COVID-19 pandemic and its peaks were investigated (January 2018-2022). Also, the desired variables including the frequency of hospitalized patients (known and new cases), the frequency of DKA, the severity of DKA, the duration of discharge from DKA, age, body mass index, duration of hospitalization, clinical symptoms including cerebral edema, laboratory data and the total daily dose insulin required at the time of discharge were compared and statistically analyzed. RESULTS Out of the 334 hospitalized T1DM patients, the rate of new T1DM patients was significantly higher (P = 0.006) during the pandemic. Clearly, there were more cases of DKA during the pandemic (P = 0.007). The higher severity of DKA (0.026) and the need for higher doses of insulin (P = 0.005) were also observed. The hospitalization rate was higher during the corona peaks, particularly peaks 1 and 4, compared to the non-peak days of COVID-19. CONCLUSION The increase in the incidence of diabetes (new cases) in the pandemic can suggest the role of the COVID-19 virus as an igniter. Also, as a trigger for the higher incidence of DKA with higher severities, which is probably caused by more damage to the pancreatic beta cells and requires higher doses of insulin.
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Affiliation(s)
- Mohamad Ahangar Davoodi
- Department of Pediatric Endocrinology, Clinical Research Development Center of Amirkabir Hospital, Arak University of Medical Sciences, P. O. Box 3819693345, Arak, Iran.
| | - Maryam Zamanian
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Bahareh Balali
- Department of Clinical Nutrition, Master Student of Sports Physiology/Sports Nutrition, Arak University of Medical Sciences, Arak, Iran
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Hartmann-Boyce J, Highton P, Rees K, Onakpoya I, Suklan J, Curtis F, O'Mahoney L, Morris E, Kudlek L, Morgan J, Lynch R, Marpadga S, Seidu S, Khunti K. The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review. Lancet Diabetes Endocrinol 2024; 12:132-148. [PMID: 38272607 DOI: 10.1016/s2213-8587(23)00351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Igho Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Jana Suklan
- National Institute for Health and Care Research Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, UK
| | - Ffion Curtis
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Kudlek
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jessica Morgan
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Rosie Lynch
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, UK
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Wu Z, Wang J, Ullah R, Chen M, Huang K, Dong G, Fu J. Covid 19 and diabetes in children: advances and strategies. Diabetol Metab Syndr 2024; 16:28. [PMID: 38287388 PMCID: PMC10823738 DOI: 10.1186/s13098-024-01267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, there has been a notable increase in the incidence of new-onset diabetes and diabetic ketoacidosis (DKA). Simultaneously, children diagnosed with type 1 diabetes (T1D) have encountered difficulties in maintaining optimal blood glucose levels. The mechanisms underpinning these correlations still remain a puzzle. We reviewed the studies that examined changes in incidence during the pandemic. These studies utilized various metrics for comparison, which encompassed the timing of data collection, diagnostic criteria, as well as the numbers and incidence rates of diabetes and DKA. We found the incidence of diabetes and DKA was higher during the pandemic. As to mechanisms, the invivo and invitro study revealed the factors such as direct viral damage, metabolic dysfunction, and immune responses all attribute to the process of T1D after suffering from COVID-19. Furthermore, we provide some useful strategies to prevent and treat children suffering from diabetes and COVID-19. CONCLUSIONS Strong correlations have been observed between new-onset diabetes and COVID-19. Insights gleaned from clinical descriptions and basic research can offer valuable experience and recommendations for the treatment and prevention of diabetes during future pandemics.
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Affiliation(s)
- Zhaoyuan Wu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jinling Wang
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Rahim Ullah
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Minghao Chen
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guanping Dong
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Junfen Fu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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Iskander C, Stukel TA, Diong C, Guan J, Saunders N, Cohen E, Brownell M, Mahar A, Shulman R, Gandhi S, Guttmann A. Acute health care use among children during the first 2.5 years of the COVID-19 pandemic in Ontario, Canada: a population-based repeated cross-sectional study. CMAJ 2024; 196:E1-E13. [PMID: 38228342 PMCID: PMC10802996 DOI: 10.1503/cmaj.221726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The effects of the decline in health care use at the start of the COVID-19 pandemic on the health of children are unclear. We sought to estimate changes in rates of severe and potentially preventable health outcomes among children during the pandemic. METHODS We conducted a repeated cross-sectional study of children aged 0-17 years using linked population health administrative and disease registry data from January 2017 through August 2022 in Ontario, Canada. We compared observed rates of emergency department visits and hospital admissions during the pandemic to predicted rates based on the 3 years preceding the pandemic. We evaluated outcomes among children and neonates overall, among children with chronic health conditions and among children with specific diseases sensitive to delays in care. RESULTS All acute care use for children decreased immediately at the onset of the pandemic, reaching its lowest rate in April 2020 for emergency department visits (adjusted relative rate [RR] 0.28, 95% confidence interval [CI] 0.28-0.29) and hospital admissions (adjusted RR 0.43, 95% CI 0.42-0.44). These decreases were sustained until September 2021 and May 2022, respectively. During the pandemic overall, rates of all-cause mortality, admissions for ambulatory care-sensitive conditions, newborn readmissions or emergency department visits or hospital admissions among children with chronic health conditions did not exceed predicted rates. However, after declining significantly between March and May 2020, new presentations of diabetes mellitus increased significantly during most of 2021 (peak adjusted RR 1.49, 95% CI 1.28-1.74 in July 2021) and much of 2022. Among these children, presentations for diabetic ketoacidosis were significantly higher than expected during the pandemic overall (adjusted RR 1.14, 95% CI 1.00-1.30). We observed similar time trends for new presentations of cancer, but we observed no excess presentations of severe cancer overall (adjusted RR 0.91, 95% CI 0.62-1.34). INTERPRETATION In the first 30 months of the pandemic, disruptions to care were associated with important delays in new diagnoses of diabetes but not with other acute presentations of select preventable conditions or with mortality. Mitigation strategies in future pandemics or other health system disruptions should include education campaigns around important symptoms in children that require medical attention.
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Affiliation(s)
- Carina Iskander
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Therese A Stukel
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Christina Diong
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Jun Guan
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Natasha Saunders
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Eyal Cohen
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Marni Brownell
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Alyson Mahar
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Rayzel Shulman
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Sima Gandhi
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Astrid Guttmann
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man.
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Puthusseril J, Lowes A, Heksch R. New Onset Diabetes Mellitus With COVID-19 Infection in a 5-Month Old. Clin Pediatr (Phila) 2024:99228231224845. [PMID: 38205740 DOI: 10.1177/00099228231224845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Affiliation(s)
- Jubel Puthusseril
- Graduate Medical Education, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
| | - Alicia Lowes
- Division of Pediatric Endocrinology, Akron Children's Hospital, Akron, OH, USA
| | - Ryan Heksch
- Graduate Medical Education, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
- Division of Pediatric Endocrinology, Akron Children's Hospital, Akron, OH, USA
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Karavanaki K, Karanasios S, Soldatou A, Tsolia M. SARS-CoV-2 vaccination in children and adolescents with and without type 1 diabetes mellitus. Endocrine 2023; 82:226-236. [PMID: 37587391 PMCID: PMC10543146 DOI: 10.1007/s12020-023-03471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
Adults with Diabetes Mellitus (DM) have increased risk of severe clinical presentation during COVID-19 infection, while children and adolescents with type 1 diabetes (T1D) have the same mild clinical course as their healthy peers, especially those with optimal glycemic control. The present review focuses on the necessity of COVID-19 vaccination among children and adolescents with T1D, and also in their non-diabetic peers. The efficacy and safety of COVID-19 vaccines are also discussed, as well as their various side-effects, ranging from common mild to very rare and serious ones. Furthermore, the results of COVID-19 vaccination of adolescents with and without T1D are reported, as well as the efficacy and concerns about childhood vaccination. It is concluded that patients with DM of all age groups should maintain optimal diabetic control in order to avoid glycemic deterioration during COVID-19 infection. Furthermore, despite the very rare and serious complications of COVID-19 vaccines, vaccination against COVID-19 is recommended for children and adolescents with T1D to prevent glycemic deterioration and rare but serious complications of COVID-19 infection.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece.
| | - Maria Tsolia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
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Kashfi K, Anbardar N, Asadipooya A, Asadipooya K. Type 1 Diabetes and COVID-19: A Literature Review and Possible Management. Int J Endocrinol Metab 2023; 21:e139768. [PMID: 38666042 PMCID: PMC11041820 DOI: 10.5812/ijem-139768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 04/28/2024] Open
Abstract
Context Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection normally damages the respiratory system but might likewise impair endocrine organs' function. Thyroid dysfunction and hyperglycemia are common endocrine complications of SARS-CoV-2 infection. The onset of type 1 diabetes (T1D) and associated complications, including diabetic ketoacidosis (DKA), hospitalization, and death, are thought to have increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to review the available data about the incidence rate of T1D and accompanying complications since the beginning of the COVID-19 pandemic. Evidence Acquisition A literature review was conducted using the electronic databases PubMed and Google Scholar. The keywords "T1D, T1DM, Type 1 DM or Type 1 Diabetes", "Coronavirus, SARS-CoV-2 or COVID-19" were used to search these databases. Titles and abstracts were screened for selection, and then relevant studies were reviewed in full text. Results A total of 25 manuscripts out of 304 identified studies were selected. There were 15 (60%) multicenter or nationwide studies. The data about the incidence rate of T1D, hospitalization, and death are not consistent across countries; however, DKA incidence and severity seem to be higher during the COVID-19 pandemic. The present study's data collection demonstrated that COVID-19 might or might not increase the incidence of T1D. Nevertheless, it is associated with the higher incidence and severity of DKA in T1D patients. This finding might indicate that antivirals are not fully protective against the endocrine complications of SARS-CoV-2 infection, which promotes the application of an alternative approach. Conclusions Combining medications that reduce SARS-CoV-2 entry into the cells and modulate the immune response to infection is an alternative practical approach to treating COVID-19.
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Affiliation(s)
- Kebria Kashfi
- Department of Clinical Medicine, Florida International University AUACOM, Florida, USA
| | - Narges Anbardar
- Department of Clinical Medicine, SMUSOM, Cleveland Clinic Lerner College of Medicine, Ohio, USA
| | - Artin Asadipooya
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Kamyar Asadipooya
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, Kentucky, USA
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Agarwal A, Bansal D, Nallasamy K, Jayashree M, William V. Pediatric Diabetes and Diabetic Ketoacidosis After COVID-19: Challenges Faced and Lessons Learnt. Pediatric Health Med Ther 2023; 14:281-288. [PMID: 37691882 PMCID: PMC10488656 DOI: 10.2147/phmt.s384104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic affected the management and follow-up of several chronic ailments, including pediatric type 1 diabetes mellitus (T1DM). Restricted access to healthcare and fear of contracting the virus during medical facility visits resulted in poor compliance, irregular follow-up visits, treatment, and delayed diagnosis of complications in pediatric diabetes such as diabetic ketoacidosis (DKA). As such, the incidence of complicated DKA in resource-limited settings is high due to delayed presentation, poor compliance with therapy, and associated comorbidities such as malnutrition and sepsis. The pandemic had only added to the woes. The increased surge in DKA, in the face of limited resources, prompted clinicians to find alternative solutions to manage these children effectively. In this narrative review, we discuss the key challenges faced globally while caring for children with T1DM and DKA during the COVID-19 pandemic, and the lessons learned thereof.
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Affiliation(s)
- Ashish Agarwal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepankar Bansal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Vijai William
- Division of Pediatric Critical Care, Department of Critical Care, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Romero RG, Riera LB, Marcos NS, Constanti VA, de la Maza VTS, Luaces C. New-onset type 1 diabetes mellitus in the Paediatric Emergency Department: impact of the COVID-19 pandemic. Ann Pediatr Endocrinol Metab 2023; 28:215-218. [PMID: 37798896 PMCID: PMC10556438 DOI: 10.6065/apem.2346088.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/22/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE On the 14th of March 2020, the Spanish government decreed a state of alarm due to the coronavirus disease 2019 (COVID-19) pandemic, directly affecting healthcare. This situation led to delayed diagnosis of several serious diseases, and its impact on many diseases such as the onset of type 1 diabetes mellitus (T1DM) remains unknown. The aim of this study is to determine the impact of the COVID-19 pandemic on the onset of T1DM in children. METHODS A descriptive-observational study was performed using data from children younger than 18 years (n=115) admitted with diagnosis of T1DM. We compared the 8 months from May-December 2020 to the same timeframe in 2019. RESULTS Our data show an increase of newly attended cases of T1DM in 2020, due to referral of Catalan children with onset of diabetes to our centre. Moreover, fewer patients presented with simple hyperglycaemia at the onset of the COVID-19 period. Delay in consulting the hospital, decreased access to the healthcare system, and avoidance of hospitals to minimize exposure to COVID-19 could have contributed to this finding. There were no differences in the number of days of hospitalization (including days in the paediatric intensive care uniy) between the years. CONCLUSION The effects of the lockdown during the COVID-19 pandemic not only delayed the diagnosis of diabetes, but also its allowed time for its severity to increase. Future studies should focus on the influence of new variants of COVID-19 on the onset of T1DM during the postvaccination period.
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Affiliation(s)
| | - Laia Baleta Riera
- Pediatrics Department, Sant Joan de Déu Children’s Hospital, Barcelona, Spain
| | - Nuria Sanz Marcos
- Pediatrics Emergency Department, Sant Joan de Déu Children’s Hospital, Barcelona, Spain
| | | | | | - Carles Luaces
- Pediatrics Emergency Department, Sant Joan de Déu Children’s Hospital, Barcelona, Spain
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12
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Memar EHE, Mohsenipour R, Sadrosadat ST, Rostami P. Pediatric endocrinopathies related to COVID-19: an update. World J Pediatr 2023; 19:823-834. [PMID: 36480134 PMCID: PMC9734372 DOI: 10.1007/s12519-022-00662-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the seventh coronavirus to be linked to human disease. The SARS-CoV-2 virus may have several pathophysiologic interactions with endocrine systems, resulting in disruptions in glucose metabolism, hypothalamus and pituitary function, adrenal function, and mineral metabolism. An increasing amount of evidence demonstrates both the influence of underlying endocrine abnormalities on the outcome of COVID-19 and the effect of the SARS-CoV-2 virus on endocrine systems. However, a systematic examination of the link to pediatric endocrine diseases has been missing. DATA SOURCES The purpose of this review is to discuss the impact of SARS-CoV-2 infection on endocrine systems and to summarize the available knowledge on COVID-19 consequences in children with underlying endocrine abnormalities. For this purpose, a literature search was conducted in EMBASE, and data that were discussed about the effects of COVID-19 on endocrine systems were used in the current study. RESULTS Treatment suggestions were provided for endocrinopathies associated with SARS-CoV-2 infection. CONCLUSIONS With the global outbreak of COVID-19, it is critical for pediatric endocrinologists to understand how SARS-CoV-2 interacts with the endocrine system and the therapeutic concerns for children with underlying problems who develop COVID-19. While children and adults share certain risk factors for SARS-CoV-2 infection sequelae, it is becoming obvious that pediatric responses are different and that adult study results cannot be generalized. While pediatric research gives some insight, it also shows the need for more study in this area.
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Affiliation(s)
| | - Reihaneh Mohsenipour
- Growth and Development Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Taravat Sadrosadat
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastoo Rostami
- Growth and Development Research Center, Department of Endocrinology and Metabolism, Pediatric Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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13
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Jalilova A, Ata A, Demir G, Işıklar H, Atik Altınok Y, Özen S, Darcan Ş, Gökşen D. The Effect of the SARS-CoV-2 Pandemic on Presentation with Diabetic Ketoacidosis in Children with New Onset Type 1 Diabetes Mellitus. J Clin Res Pediatr Endocrinol 2023; 15:264-267. [PMID: 36987789 PMCID: PMC10448546 DOI: 10.4274/jcrpe.galenos.2023.2022-11-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Objective Diabetic ketoacidosis (DKA) is a life-threatening, acute complication of type 1 diabetes mellitus (T1DM). Infection is the most common precipitating factor for DKA, being responsible for more than 50% of such complications. The frequency and severity of DKA in children with T1DM, before and during the coronavirus disease 2019 outbreak were evaluated and compared with pre-pandemic presentation and severity rates. Methods In total, 199 patients younger than 18 years were included in the study. Patients were divided into two groups: the Coronavirus disease-2019 (COVID-19) pandemic group (new onset T1DM presenting from March 2020 to March 2021; the control group included new onset T1DM from March 2016 to March 2020. Results The rate of DKA at presentation was similar (p=0.393) during the pandemic period (58.3%) compared to the pre-pandemic years (44.8-64.3%). Although the percentage of DKA was similar, the rate of severe DKA in the COVID-19 group was higher than previous years. Although not significant, the duration of diabetes symptoms was longer in the COVID-19 period than the previous years. Conclusion This study suggests that the rate of severe DKA, but not the overall rate of DKA, has increased during the COVID-19 pandemic compared to the prior four years. This may be due to the behavior of the parents of sick children and the limited access to the healthcare system. Despite this limited access, parental concern may have been sufficiently high to seek medical attention for their children, avoiding an increased frequency of DKA as the first presentation of new-onset T1DM.
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Affiliation(s)
- Arzu Jalilova
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Aysun Ata
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Günay Demir
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Hafize Işıklar
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Yasemin Atik Altınok
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
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14
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Calcaterra V, Tagi VM, De Santis R, Biuso A, Taranto S, D’Auria E, Zuccotti G. Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review. J Clin Med 2023; 12:5248. [PMID: 37629291 PMCID: PMC10455095 DOI: 10.3390/jcm12165248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Since the advent of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increased incidence of several endocrinological anomalies in acute-phase and/or long-term complications has been described. The aim of this review is to provide a broad overview of the available literature regarding changes in the worldwide epidemiology of endocrinological involvement in children since December 2019 and to report the evidence supporting its association with coronavirus disease 2019 (COVID-19). Although little is known regarding the involvement of endocrine organs during COVID-19 in children, the current evidence in adults and epidemiological studies on the pediatric population suggest the presence of a causal association between the virus and endocrinopathies. Untreated transient thyroid dysfunction, sick euthyroid syndrome, nonthyroidal illness syndrome, and hypothalamic-pituitary-adrenal (HPA) axis and central precocious puberty have been observed in children in acute infection and/or during multisystem inflammatory syndrome development. Furthermore, a higher frequency of ketoacidosis at onset in children with a new diagnosis of type 1 diabetes is reported in the literature. Although the direct association between COVID-19 and endocrinological involvement has not been confirmed yet, data on the development of different endocrinopathies in children, both during acute infection and as a result of its long-term complications, have been reported. This information is of primary importance to guide the management of patients with previous or current COVID-19.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Veronica Maria Tagi
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Raffaella De Santis
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Andrea Biuso
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Silvia Taranto
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20122 Milan, Italy
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15
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Meregildo-Rodriguez ED, León-Jiménez FE, Tafur-Hoyos BAD, Vásquez-Tirado GA. Impact of the COVID-19 pandemic on the incidence and clinical outcomes of diabetic ketoacidosis among male and female children with type 1 diabetes: systematic review and meta-analysis. F1000Res 2023; 12:72. [PMID: 39262444 PMCID: PMC11387936 DOI: 10.12688/f1000research.128687.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/13/2024] Open
Abstract
Background: Some studies suggest that the SARS-CoV-2 pandemic increased the incidence of type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA). However, the impact of this pandemic on pediatric T1DM is still mostly unknown. Therefore, we aimed to assess the effect of the COVID-19 pandemic on clinical outcomes in children with T1DM. Methods: We systematically searched for six databases up to 31 August 2022. We included 46 observational studies, 159,505 children of both sexes with T1DM, and 17,547 DKA events. Results: The COVID-19 pandemic significantly increased, in both sexes, the incidence of 1) DKA (OR 1.68; 95% CI 1.44-1.96), 2) severe DKA (OR 1.84; 95% CI 1.59-2.12), 3) DKA in newly diagnosed T1DM (OR 1.75; 95% CI 1.51-2.03), and 4) ICU admissions (OR 1.90; 95% CI 1.60-2.26). However, we did not find a significant association between this pandemic and 1) the incidence of T1DM, 2) the incidence of DKA in established T1DM, 3) the incidence of KDA complications, 4) the length of hospitalization stay, and 5) mortality. Subgroup analysis showed that the study design and the continent of origin accounted for the heterogeneity. Conclusions: The pandemic SARS-CoV-2 raised, in both sexes, the risk of DKA, severe DKA, DKA de novo, and ICU admissions.
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16
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Fotea S, Ghiciuc CM, Stefanescu G, Cianga AL, Mihai CM, Lupu A, Butnariu LI, Starcea IM, Salaru DL, Mocanu A, Chisnoiu T, Thet AA, Miron L, Lupu VV. Pediatric COVID-19 and Diabetes: An Investigation into the Intersection of Two Pandemics. Diagnostics (Basel) 2023; 13:2436. [PMID: 37510181 PMCID: PMC10378192 DOI: 10.3390/diagnostics13142436] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a complex infectious disease caused by the SARS-CoV-2 virus, and it currently represents a worldwide public health emergency. The pediatric population is less prone to develop severe COVID-19 infection, but children presenting underlying medical conditions, such as diabetes mellitus, are thought to be at increased risk of developing more severe forms of COVID-19. Diabetic children face new challenges when infected with SARS-CoV-2. On one hand, the glycemic values become substantially more difficult to manage as COVID-19 is a predisposing factor for hyperglycemia. On the other hand, alongside other risk factors, high glycemic values are incriminated in modulating immune and inflammatory responses, leading to potentially severe COVID-19 cases in the pediatric population. Also, there are hypotheses of SARS-CoV-2 being diabetogenic itself, but this information is still to be confirmed. Furthermore, it is reported that there was a noticeable increase in the number of cases of new-onset type 2 diabetes among the pediatric population, and the complications in these patients with COVID-19 include the risk of developing autoimmune diseases under the influence of stress. Additionally, children with diabetes mellitus are confronted with lifestyle changes dictated by the pandemic, which can potentially lead to the onset or exacerbation of a potential underlying anxiety disorder or depression. Since the literature contains a series of unknowns related to the impact of COVID-19 in both types of diabetes in children, the purpose of our work is to bring together the data obtained so far and to identify potential knowledge gaps and areas for future investigation regarding COVID-19 and the onset of diabetes type 1 or type 2 among the pediatric population.
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Affiliation(s)
- Silvia Fotea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Department of Morpho-Functional Sciences II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Stefanescu
- I-st Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Lavinia Cianga
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Maria Mihai
- Pediatrics, Faculty of General Medicine, Ovidius University, 900470 Constanta, Romania
| | - Ancuta Lupu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iuliana Magdalena Starcea
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Delia Lidia Salaru
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adriana Mocanu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Tatiana Chisnoiu
- Pediatrics, Faculty of General Medicine, Ovidius University, 900470 Constanta, Romania
| | - Aye Aung Thet
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lucian Miron
- III-rd Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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17
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Nimali Seneviratne S, Kumarihamy Karunathilake CN, Pallegama CM, Malintha Lahiru TG, Jayarajah U. Endocrine manifestations of COVID-19 in children: A scoping review. Best Pract Res Clin Endocrinol Metab 2023; 37:101792. [PMID: 37453832 PMCID: PMC10303324 DOI: 10.1016/j.beem.2023.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
In this review, we explore associations between SARS CoV-2 infection and the endocrine system and metabolism in children and adolescents. PubMed, Scopus and Google scholar databases were searched to identify published data on endocrine manifestations of COVID-19 in children up to 31 March 2023, including diabetes, obesity, puberty, thyroid disorders, adrenal disorders and pituitary disorders. Data on changes in disease pattern/ incidence, disease control, and other effects due to the COVID-19 pandemic, as well as effects of pre-existing endocrine conditions on severity of COVID-19 infection are presented, and practice points and research needs provided under each section.
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Affiliation(s)
| | | | | | | | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Sri Lanka; Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka.
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18
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Ingrosso DMF, Quarta MT, Quarta A, Chiarelli F. Prevention of Type 1 Diabetes in Children: A Worthy Challenge? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5962. [PMID: 37297566 PMCID: PMC10252671 DOI: 10.3390/ijerph20115962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/19/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Nowadays, the development of new immuno-therapeutic drugs has made it possible to alter the course of many autoimmune diseases. Type 1 diabetes is a chronic disease with a progressive dependence on exogenous insulin administration. The ability to intercept individuals at high risk of developing type 1 diabetes is the first step toward the development of therapies that can delay the process of β-cell destruction, thus permitting a better glycemic control and reducing the incidence of ketoacidosis. The knowledge of the main pathogenetic mechanisms underlying the three stages of the disease may be helpful to identify the best immune therapeutic approach. In this review, we aim to give an overview of the most important clinical trials conducted during the primary, secondary and tertiary phases of prevention.
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Affiliation(s)
| | | | | | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti, Via dei Vestini, 66100 Chieti, Italy
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19
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Karavanaki K, Rodolaki K, Soldatou A, Karanasios S, Kakleas K. Covid-19 infection in children and adolescents and its association with type 1 diabetes mellitus (T1d) presentation and management. Endocrine 2023; 80:237-252. [PMID: 36462147 PMCID: PMC9734866 DOI: 10.1007/s12020-022-03266-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022]
Abstract
Children seem to be affected by the new SARS-CoV-2 virus less severely than adults, with better prognosis and low mortality. Serious complications of COVID-19 infection in children include multisystem inflammatory response syndrome in COVID-19 infection (MIS-C), myo-or pericarditis and, less frequently, long COVID syndrome. On the other hand, adults with type 1 (T1D) or type 2 diabetes (T2D) are among the most vulnerable groups affected by COVID-19, with increased morbidity and mortality. Moreover, an association of SARS-CoV-2 with diabetes has been observed, possibly affecting the frequency and severity of the first clinical presentation of T1D or T2D, as well as the development of acute diabetes after COVID-19 infection. The present review summarizes the current data on the incidence of T1D among children and adolescents during the COVID-19 pandemic, as well as its severity. Moreover, it reports on the types of newly diagnosed diabetes after COVID infection and the possible pathogenetic mechanisms. Additionally, this study presents current data on the effect of SARS-CoV-2 on diabetes control in patients with known T1D and on the severity of clinical presentation of COVID infection in these patients. Finally, this review discusses the necessity of immunization against COVID 19 in children and adolescents with T1D.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Kalliopi Rodolaki
- First Department of Pediatrics, National and Kapodistrian University of Athens,"Aghia Sophia" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Kostas Kakleas
- First Department of Pediatrics, National and Kapodistrian University of Athens,"Aghia Sophia" Children's Hospital, Athens, Greece.
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20
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de Vries SAG, Bak JCG, Verheugt CL, Stangenberger VA, Mul D, Wouters MWJM, Nieuwdorp M, Sas TCJ. Healthcare expenditure and technology use in pediatric diabetes care. BMC Endocr Disord 2023; 23:72. [PMID: 37029362 PMCID: PMC10080182 DOI: 10.1186/s12902-023-01316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/06/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Diabetes mellitus is one of the most common chronic diseases in childhood. With more advanced care options including ever-evolving technology, allocation of resources becomes increasingly important to guarantee equal care for all. Therefore, we investigated healthcare resource utilization, hospital costs, and its determinants in Dutch children with diabetes. METHODS We conducted a retrospective, observational analysis with hospital claims data of 5,474 children with diabetes mellitus treated in 64 hospitals across the Netherlands between 2019-2020. RESULTS Total hospital costs were €33,002,652 per year, and most of these costs were diabetes-associated (€28,151,381; 85.3%). Mean annual diabetes costs were €5,143 per child, and treatment-related costs determined 61.8%. Diabetes technology significantly increased yearly diabetes costs compared to no technology: insulin pumps € 4,759 (28.7% of children), Real-Time Continuous Glucose Monitoring € 7,259 (2.1% of children), and the combination of these treatment modalities € 9,579 (27.3% of children). Technology use increased treatment costs significantly (5.9 - 15.3 times), but lower all-cause hospitalisation rates were observed. In all age groups, diabetes technology use influenced healthcare consumption, yet in adolescence usage decreased and consumption patterns changed. CONCLUSIONS These findings suggest that contemporary hospital costs of children with diabetes of all ages are driven primarily by the treatment of diabetes, with technology use as an important additive factor. The expected rise in technology use in the near future underlines the importance of insight into resource use and cost-effectiveness studies to evaluate if improved outcomes balance out these short-term costs of modern technology.
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Affiliation(s)
- Silvia A G de Vries
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Jessica C G Bak
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Dick Mul
- Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Theo C J Sas
- Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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21
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Elgenidy A, Awad AK, Saad K, Atef M, El-Leithy HH, Obiedallah AA, Hammad EM, Ahmad FA, Ali AM, Dailah HG, Elhoufey A, Taha SF. Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes. Pediatr Res 2023; 93:1149-1160. [PMID: 35953513 PMCID: PMC9366798 DOI: 10.1038/s41390-022-02241-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/29/2022] [Accepted: 07/24/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes mellitus (T1DM) that has increased during the COVID-19 pandemic. This study will not only shed light on such life-threatening complications but also be a step to increase the awareness of healthcare providers about such complications in the upcoming pandemic waves and increased dependence on telemedicine. Thus, we aimed to further investigate the increase of DKA in pediatrics. METHODS PubMed, Web of Science, and Scopus were broadly searched for studies assessing the incidence of DKA in pediatrics during the COVID-19 pandemic. RESULTS Our study included 24 papers with a total of 124,597 children with diabetes. A statistically significant increase occurred in the risk of DKA among newly diagnosed T1DM patients during the pandemic (RR 1.41; 95% CI 1.19, 1.67; p < 0.01; I2 = 86%), especially in the severe form of DKA (RR 1.66: 95% CI 1.3, 2.11) when compared to before. CONCLUSION DKA in newly diagnosed children with T1DM has increased during the pandemic and presented with a severe form. This may reflect that COVID-19 may have contributed not only to the development but also the severity of DKA. IMPACT Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) that has increased during the COVID-19 pandemic. Our study included 25 papers with a total of 124,597 children with diabetes. A statistically significant increase occurred in the risk of DKA among newly diagnosed T1DM patients during the pandemic. Our findings reflect that COVID-19 may have an altered presentation in T1DM and can be related to DKA severity.
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Affiliation(s)
| | - Ahmed K Awad
- Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Khaled Saad
- Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Mostafa Atef
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ahmed A Obiedallah
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Emad M Hammad
- Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmad M Ali
- Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hamad Ghaleb Dailah
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan, Saudi Arabia
| | - Amira Elhoufey
- Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt
- Department of Community Health Nursing, Alddrab University College, Jazan University, Jazan, Saudi Arabia
| | - Samaher Fathy Taha
- Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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22
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Albuali WH, Yousef AA, Al-Qahtani MH, AlQurashi FO, Albuali HW, Yousef HA, Aldajani AA, Ghamdi MAA, AlBassam BN. A Clinical and Biochemical Comparative Study Of Diabetic Ketoacidosis (DKA) in Newly Diagnosed Vs Known Cases of Type 1 Diabetic Children. Rev Diabet Stud 2023; 19:28-33. [PMID: 37185051 PMCID: PMC10082331 DOI: 10.1900/rds.2023.19.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Objectives: We aimed to study the characterizing clinical and biochemical profiles of Diabetic Ketoacidosis (DKA) in children with newly diagnosed Type 1 Diabetes Mellitus (Type 1DM) compared to children with established diagnosis of Type 1DM presenting with DKA admitted to the pediatric intensive care unit of a large university hospital in the eastern region of Saudi Arabia. Methods: We retrospectively reviewed the medical records of 211 patients who were admitted to the pediatric intensive care unit with diabetic ketoacidosis between 2010 and 2019. The diagnosis of diabetic ketoacidosis was based on symptoms of polydipsia, polyurea, weight loss, vomiting, dehydration, abdominal pain, breathing problems, lethargy or coma, biochemical hyperglycemia (blood glucose level of >200 mg/dL), venous pH of <7.3, serum bicarbonate level of ≤15 mEq/L, and ketonemia (blood β -hydroxybutyrate concentration of ≥3 mM) or moderate or severe ketonuria (diagnosed as newly acquired type 1 diabetes). Results: The rate of newly diagnosed Type 1 DM with DKA was 41.7%, out of them who got severe and moderate diabetic ketoacidosis were 61.6% and 38.4%, respectively. We observed significantly increased heart and respiratory rates in patients newly diagnosed with diabetic ketoacidosis and in those with severe diabetic ketoacidosis (p<0.001) compared to known cases with Type 1DM presenting with DKA. We also identified significantly increased biochemical indices including HbA1c, random blood sugar, serum osmolality, blood urea nitrogen, creatinine, chloride, lactate, and anion gap in relation to severe diabetic ketoacidosis and newly diagnosed type 1 diabetes (p ≤ 0.05). Conclusions: We found that the clinical and biochemical profiles of patients with newly diagnosed Type 1 DM children were significantly affected compared to children who were known Type 1DM presenting with DKA.
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Affiliation(s)
- Waleed H Albuali
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah A Yousef
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad H Al-Qahtani
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal O AlQurashi
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hamad W Albuali
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haneen A Yousef
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ala'a A Aldajani
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed A Al Ghamdi
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bassam N AlBassam
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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23
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Zucchini S, Scozzarella A, Maltoni G. Multiple influences of the COVID-19 pandemic on children with diabetes: Changes in epidemiology, metabolic control and medical care. World J Diabetes 2023; 14:198-208. [PMID: 37035223 PMCID: PMC10075036 DOI: 10.4239/wjd.v14.i3.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/28/2023] [Accepted: 02/23/2023] [Indexed: 03/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has heavily affected health worldwide, with the various forms of diabetes in children experiencing changes at various levels, including epidemiology, diabetic ketoacidosis rates and medical care. Type 1 diabetes showed an apparent increase in incidence, possibly owing to a direct damage of the virus to the β-cell. Diabetic ketoacidosis also increased in association with the general fear of referring patients to the hospital. Most children with diabetes (both type 1 and type 2) did not show a worsening in metabolic control during the first lockdown, possibly owing to a more controlled diet by their parents. Glucose sensor and hybrid closed loop pump technology proved to be effective in all patients with type 1 diabetes during the pandemic, especially because the downloading of data allowed for the practice of tele-medicine. Telemedicine has in fact grown around the world and National Health Systems have started to consider it as a routine activity in clinical practice. The present review encompasses all the aspects related to the effects of the pandemic on the different forms of diabetes in children.
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Affiliation(s)
- Stefano Zucchini
- Department of Pediatric, IRCCS AOU di Bologna, Bologna 40138, Italy
| | | | - Giulio Maltoni
- Department of Pediatric, IRCCS AOU di Bologna, Bologna 40138, Italy
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24
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Baechle C, Eckert A, Kamrath C, Neu A, Manuwald U, Thiele-Schmitz S, Weidler O, Knauer-Fischer S, Rosenbauer J, Holl RW. Incidence and presentation of new-onset type 1 diabetes in children and adolescents from Germany during the COVID-19 pandemic 2020 and 2021: Current data from the DPV Registry. Diabetes Res Clin Pract 2023; 197:110559. [PMID: 36758641 DOI: 10.1016/j.diabres.2023.110559] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
AIMS To determine whether the incidence of type 1 diabetes mellitus (T1D), autoantibody-negative diabetes, and diabetic ketoacidosis (DKA) at diabetes onset in 2020 and 2021 changed when compared to long-standing trends. METHODS Our study is based on diabetes manifestation data of the 0.5-<18-year-old children/adolescents from the German multicenter Diabetes Prospective Follow-up Registry. Based on long-term pre-pandemic trends from 2011 to 2019, we estimated adjusted incidence rate ratios (IRR) for T1D and DKA, and prevalence rate ratios (PRR) regarding autoantibody status with 95 % confidence intervals (CI) for the years 2020 and 2021 (observed versus predicted rates), using multivariable negative binomial or beta-binomial regression, respectively. RESULTS We analyzed data of 30,840 children and adolescents with new-onset T1D. The observed incidences were significantly higher than the predicted incidences (IRR2020 1.13 [1.08-1.19]; IRR2021 1.20 [1.15-1.26]). The prevalence of autoantibody-negative diabetes did not change (PRR2020 0.91 [0.75-1.10]; PRR2021 1.03 [0.86-1.24]). The incidence of DKA during the pandemic was higher than predicted (IRR2020 1.34 [1.23-1.46]; IRR2021 1.37 [1.26-1.49]). CONCLUSIONS An increase in the incidences of T1D and DKA, but not of autoantibody-negative diabetes was observed during both pandemic years. Further monitoring and efforts for DKA prevention at onset are necessary.
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Affiliation(s)
- C Baechle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, D-85764 Munich-Neuherberg, Germany.
| | - A Eckert
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, D-85764 Munich-Neuherberg, Germany.
| | - C Kamrath
- Justus Liebig University, Center of Child and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetology, Feulgenstraße 10-12, D-35392 Giessen, Germany.
| | - A Neu
- University Hospital Tübingen, Clinic for Paediatrics and Youth Medicine, Hoppe-Seyler-Straße 1, D-72076 Tübingen, Germany.
| | - U Manuwald
- Technische Universität Dresden, Faculty of Medicine "Carl Gustav Carus", Institute and Policlinic of Occupational and Social Medicine, Health Sciences/Public Health, Fetscherstraße 74, D-01307 Dresden, Germany.
| | - S Thiele-Schmitz
- St. Louise Women's and Children's Hospital, Diabetes Center for Children and Adolescents, Husener Straße 81, D-33098 Paderborn, Germany.
| | - O Weidler
- Elbe Kliniken Stade - Buxtehude, Bremervörder Straße 111, D-21682 Stade, Germany.
| | - S Knauer-Fischer
- University Hospital Mannheim, Clinic for Pediatric and Adolescent Medicine, Division of Endocrinology and Diabetology, Theodor-Kutzer-Ufer 1, D-368167 Mannheim, Germany.
| | - J Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, D-85764 Munich-Neuherberg, Germany.
| | - R W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, D-85764 Munich-Neuherberg, Germany.
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25
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Azova S, Liu E, Wolfsdorf J. Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic. Pediatr Diabetes 2023; 2023:5123197. [PMID: 38050487 PMCID: PMC10695073 DOI: 10.1155/2023/5123197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
The incidence of pediatric diabetic ketoacidosis (DKA) increased during the peak of the COVID-19 pandemic. The objective of this study was to investigate whether rates of hyperosmolar therapy administration for suspected clinically apparent brain injury (CABI) complicating DKA also increased during this period as compared to the three years immediately preceding the pandemic and to compare the characteristics of patients with suspected CABI before the pandemic, patients with suspected CABI during the peak of the pandemic, and those with DKA but without suspected CABI during the pandemic. Patients aged ≤18 years presenting with DKA before (March 11, 2017-March 10, 2020) and during the peak of the pandemic (March 11, 2020-March 10, 2021) were identified through a rigorous search of two databases. Predefined criteria were used to diagnose suspected CABI. Biochemical, clinical, and sociodemographic data were collected from a comprehensive review of the electronic medical record. The proportion of patients with DKA who received hyperosmolar therapy was significantly higher (P = 0.014) during the pandemic compared to the prepandemic period; however, this was only significant among patients with newly diagnosed diabetes. Both groups with suspected CABI had more severe acidosis, lower Glasgow Coma Scale scores, and longer hospital admissions (P< 0.001 for all) than cases without suspected CABI. During the pandemic, the blood urea nitrogen concentration was significantly higher in patients with suspected CABI than those without suspected CABI, suggesting they were more severely dehydrated. The clinical, biochemical, and sociodemographic characteristics of patients with suspected CABI were indistinguishable before and during the pandemic. In conclusion, administration of hyperosmolar therapy for suspected CABI was more common during the peak of the COVID-19 pandemic, possibly a result of delayed presentation, highlighting the need for increased awareness and early recognition of the signs and symptoms of diabetes and DKA, especially during future surges of highly transmissible infections.
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Affiliation(s)
- Svetlana Azova
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
| | - Joseph Wolfsdorf
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
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26
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Boggiss AL, Consedine NS, Hopkins S, Silvester C, Jefferies C, Hofman P, Serlachius AS. A Self-Compassion Chatbot to Improve the Wellbeing of Adolescents with Type 1 Diabetes During the COVID-19 Pandemic: What do Adolescents and their Healthcare Professionals Want? JMIR Diabetes 2023; 8:e40641. [PMID: 36939680 PMCID: PMC10166132 DOI: 10.2196/40641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Prior to the coronavirus (COVID-19) pandemic, adolescents with type 1 diabetes (T1D) already experienced far greater rates of psychological distress than their peers. With the pandemic further challenging mental health and increasing the barriers to maintaining optimal diabetes self-management, it is vital this population has access to remotely deliverable, evidence-based interventions to improve psychological and diabetes outcomes. Chatbots, defined as digital conversational agents, offer these unique advantages, as well as the ability to engage in empathetic and personalized conversations 24/7. Building on previous work developing a self-compassion program for adolescents with T1D, a self-compassion chatbot was developed for adolescents with T1D to address these concerns. However, the acceptability and potential clinical usability of a chatbot to deliver self-compassion coping tools to adolescents with T1D remained unknown. OBJECTIVE This qualitative study was designed to evaluate the acceptability and potential clinical utility of a novel self-compassion chatbot (called 'COMPASS') among adolescents aged 12 to 16 years with T1D and their diabetes healthcare professionals. METHODS Potential adolescent participants were recruited from previous participant lists, and online and in-clinic study flyers, whereas healthcare professionals were recruited from clinic emails and diabetes research special interest groups. Qualitative Zoom interviews exploring views on a newly developed self-compassion chatbot were conducted with 19 adolescents (in 4 focus groups), and 11 diabetes healthcare professionals (in 2 focus groups and 6 individual interviews), from March to April 2022. Transcripts were analyzed using directed content analysis to examine the features and content of greatest importance to both groups. RESULTS Adolescents were broadly representation of the youth population living with T1D in Aotearoa (58% female, 68% Aotearoa New Zealand European, 11% Māori). Healthcare professionals represented a range of disciplines including Diabetes Nurse Specialists (n = 3), Health Psychologists (n = 3), Dieticians (n = 3), and Endocrinologists (n = 2). Findings offer early insight into what adolescents with T1D and their healthcare professionals see as shared advantages of COMPASS and desired future additions, such as personalization (mentioned by all 19 adolescents), self-management support (mentioned by 13 of 19 adolescents), clinical utility (mentioned by all 11 healthcare professionals), and breadth and flexibility of tools (mentioned by 10 of 11 healthcare professionals). CONCLUSIONS Early data suggest that a self-compassion chatbot for adolescents with T1D is acceptable, relevant to common difficulties, and offers clinical utility during the COVID-19 pandemic. However, shared desired features amongst both groups, including problem-solving and integration with diabetes technology to support self-management, creating a safe peer-to-peer sense of community, and broadening the representation of different cultures, lived experience stories, and diabetes challenges, could further improve the potential of the chatbot. Based on these findings, the COMPASS chatbot is currently being improved to be tested in a future feasibility study. CLINICALTRIAL
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Affiliation(s)
- Anna Lynette Boggiss
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | - Nathan Sacha Consedine
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | - Sarah Hopkins
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | | | - Craig Jefferies
- Starship Children's Health, Auckland City Hospital, Auckland, NZ
| | - Paul Hofman
- Liggins Institute, University of Auckland, Auckland, NZ
| | - Anna Sofia Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
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27
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Ditkovskaya LV, Aleksandrovich YS, Pshenisnov KV, Demchuk YA, Fel’ker EY. Severe course of diabetic ketoacidosis due to new coronavirus infection in older children (clinical cases). JOURNAL INFECTOLOGY 2023. [DOI: 10.22625/2072-6732-2022-14-5-101-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The risk of severe type I diabetes mellitus in children with new coronavirus infection (COVID-19) is extremely high, which is associated with a high risk of intracranial hypertension, cerebral edema and multiple organ dysfunction syndrome. On the example of a clinical case, the features of the course of diabetic ketoacidosis and intensive care measures in children with COVID-19 were considered. The main data of the history and clinical and laboratory examination are reflected, special attention is paid to the applied aspects of therapy, it was noted that with a severe course of a new coronavirus infection and diabetic ketoacidosis, the risk of developing cerebral injury, acute kidney injury and thromboembolic complications is quite high, which may require artificial lung ventilation for the purpose of cerebral protection, renal replacement therapy and the use of anticoagulants. The new coronavirus infection is a risk factor for the severe course of diabetic ketoacidosis in children with type I diabetes, regardless of the age of the child, which is the basis for clinical alertness in order to timely identify and treat potential life-threatening complications.
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28
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Rosenbauer J, Stahl‐Pehe A, Schlesinger S, Kuß O. Comments on Rahmati et al., The global impact of COVID-19 pandemic on the incidence of pediatric new-onset type 1 diabetes and ketoacidosis: A systematic review and meta-analysis. J Med Virol. 2022; 1-16 (doi: 10.1002/jmv.27996). J Med Virol 2023; 95:e28272. [PMID: 36324006 PMCID: PMC9877639 DOI: 10.1002/jmv.28272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Joachim Rosenbauer
- German Diabetes Center, Institute for Biometrics and EpidemiologyLeibniz Center for Diabetes Research at Heinrich Heine UniversityDüsseldorfGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Anna Stahl‐Pehe
- German Diabetes Center, Institute for Biometrics and EpidemiologyLeibniz Center for Diabetes Research at Heinrich Heine UniversityDüsseldorfGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Sabrina Schlesinger
- German Diabetes Center, Institute for Biometrics and EpidemiologyLeibniz Center for Diabetes Research at Heinrich Heine UniversityDüsseldorfGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Oliver Kuß
- German Diabetes Center, Institute for Biometrics and EpidemiologyLeibniz Center for Diabetes Research at Heinrich Heine UniversityDüsseldorfGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
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29
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Miller A, Joseph S, Badran A, Umpaichitra V, Bargman R, Chin VL. Increased Rates of Hospitalized Children with Type 1 and Type 2 Diabetes Mellitus in Central Brooklyn during the COVID-19 Pandemic. Int J Pediatr 2023; 2023:4580809. [PMID: 37101938 PMCID: PMC10125760 DOI: 10.1155/2023/4580809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/17/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023] Open
Abstract
Following reports of increased new-onset diabetes and worse severity of DKA for children with diabetes following SARS-CoV-2 infection, we studied hospitalization rates for children with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in our center during the citywide shutdown. Methods. We conducted a retrospective chart review of children admitted to our two hospitals from January 1, 2018, to December 31, 2020. We included ICD-10 codes for diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome (HHS), and hyperglycemia only. Results. We included 132 patients with 214 hospitalizations: 157 T1DM, 41 T2DM, and 16 others (14 steroid induced, 2 MODY). Overall admissions rates for patients with all types of diabetes were 3.08% in 2018 to 3.54% in 2019 (p = 0.0120) and 4.73% in 2020 (p = 0.0772). Although there was no increase of T1DM admissions across all 3 years, T2DM admission rates increased from 0.29% to 1.47% (p = 0.0056). Newly diagnosed T1DM rates increased from 0.34% in 2018 to 1.28% (p = 0.002) in 2020, and new-onset T2DM rates also increased from 0.14% in 2018 to 0.9% in 2020 (p = 0.0012). Rates of new-onset diabetes presenting with DKA increased from 0.24% in 2018 to 0.96% in 2020 (p = 0.0014). HHS increased from 0.1% in 2018 to 0.45% in 2020 (p = 0.044). The severity of DKA in newly diagnosed was unaffected (p = 0.1582). Only 3 patients tested positive for SARS-CoV-2 infection by PCR. Conclusion. Our urban medical center is located in Central Brooklyn and serves a majority who are Black. This is the first study investigating pediatric diabetes cases admitted to Brooklyn during the first wave of the pandemic. Despite the overall pediatric admissions declining in 2020 due to the citywide shutdown, overall hospitalization rates in children with T2DM and in new-onset T1DM and T2DM increased, which is not directly associated with active SARS-CoV-2 infection. More studies are needed to elucidate the reason for this observed increase in hospitalization rates.
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Affiliation(s)
- Assia Miller
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Shalu Joseph
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Ahmed Badran
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Vatcharapan Umpaichitra
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Renee Bargman
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Vivian L. Chin
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
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30
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Scutca AC, Nicoară DM, Mărăzan M, Brad GF, Mărginean O. Neutrophil-to-Lymphocyte Ratio Adds Valuable Information Regarding the Presence of DKA in Children with New-Onset T1DM. J Clin Med 2022; 12:jcm12010221. [PMID: 36615022 PMCID: PMC9821096 DOI: 10.3390/jcm12010221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is an acute life-threatening complication occurring mainly at the onset of type 1 diabetes mellitus. The neutrophil-to-lymphocyte ratio (NLR), a marker for systemic inflammation, has recently generated increasing interest in many chronic diseases. The aim of this cross-sectional study was to determine the value of the neutrophil-to-lymphocyte ratio (NLR) in association with DKA severity across these cases. A total of 155 children with new-onset type 1 DM from one large center were included in the study. Total and differential leukocyte counts were measured upon admission and calculation of the NLR was performed. Patients were classified into four groups: without DKA, mild, moderate, and severe DKA at disease onset. Total WBCs, neutrophils, and monocytes increased with DKA severity (p-value < 0.005), while eosinophiles displayed an inverse relationship (p-value < 0.001). Median NLR scores increased from those without ketoacidosis (1.11) to mild (1.58), moderate (3.71), and severe (5.77) ketoacidosis groups. The statistical threshold value of the NLR in predicting DKA was 1.84, with a sensitivity of 80.2% and a specificity of 80%. Study findings indicate that a higher NLR score adds valuable information regarding the presence of DKA in children with new-onset T1DM.
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Affiliation(s)
- Alexandra-Cristina Scutca
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Delia-Maria Nicoară
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Correspondence:
| | - Monica Mărăzan
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Giorgiana-Flavia Brad
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Otilia Mărginean
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
- Department XI Pediatrics, Discipline I Pediatrics, Disturbances of Growth and Development in Children–BELIVE, 300011 Timisoara, Romania
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31
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Capra ME, Stanyevic B, Giudice A, Monopoli D, Decarolis NM, Esposito S, Biasucci G. The Effects of COVID-19 Pandemic and Lockdown on Pediatric Nutritional and Metabolic Diseases: A Narrative Review. Nutrients 2022; 15:nu15010088. [PMID: 36615746 PMCID: PMC9823544 DOI: 10.3390/nu15010088] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
SARS-CoV-2 was the first pathogen implied in a worldwide health emergency in the last decade. Containment measures have been adopted by various countries to try to stop infection spread. Children and adolescents have been less clinically involved by COVID-19, but the pandemic and consequent containment measures have had an important influence on the developmental ages. The COVID-19 pandemic and the subsequent lockdown periods have influenced the nutrition and lifestyles of children and adolescents, playing an epigenetic role in the development of nutrition and metabolic diseases in this delicate age group. The aim of our review is to investigate the effects of the COVID-19 pandemic on nutrition and metabolic diseases in the developmental ages. Moreover, we have analyzed the effect of different containment measures in children and adolescents. An increase in being overweight, obesity and type 2 diabetes mellitus has been detected. Concerning type 1 diabetes mellitus, although a validated mechanism possibly linking COVID-19 with new onset type 1 diabetes mellitus has not been yet demonstrated, barriers to the accessibility to healthcare services led to delayed diagnosis and more severe presentation of this disease. Further studies are needed to better investigate these relationships and to establish strategies to contain the nutritional and metabolic impact of new pandemics in the developmental ages.
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Affiliation(s)
- Maria Elena Capra
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Brigida Stanyevic
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Antonella Giudice
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Delia Monopoli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Nicola Mattia Decarolis
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Du C, Whiddett RO, Buckle I, Chen C, Forbes JM, Fotheringham AK. Advanced Glycation End Products and Inflammation in Type 1 Diabetes Development. Cells 2022; 11:3503. [PMID: 36359899 PMCID: PMC9657002 DOI: 10.3390/cells11213503] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 08/08/2023] Open
Abstract
Type 1 diabetes (T1D) is an autoimmune disease in which the β-cells of the pancreas are attacked by the host's immune system, ultimately resulting in hyperglycemia. It is a complex multifactorial disease postulated to result from a combination of genetic and environmental factors. In parallel with increasing prevalence of T1D in genetically stable populations, highlighting an environmental component, consumption of advanced glycation end products (AGEs) commonly found in in Western diets has increased significantly over the past decades. AGEs can bind to cell surface receptors including the receptor for advanced glycation end products (RAGE). RAGE has proinflammatory roles including in host-pathogen defense, thereby influencing immune cell behavior and can activate and cause proliferation of immune cells such as islet infiltrating CD8+ and CD4+ T cells and suppress the activity of T regulatory cells, contributing to β-cell injury and hyperglycemia. Insights from studies of individuals at risk of T1D have demonstrated that progression to symptomatic onset and diagnosis can vary, ranging from months to years, providing a window of opportunity for prevention strategies. Interaction between AGEs and RAGE is believed to be a major environmental risk factor for T1D and targeting the AGE-RAGE axis may act as a potential therapeutic strategy for T1D prevention.
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Affiliation(s)
- Chenping Du
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
| | - Rani O. Whiddett
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
| | - Irina Buckle
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
- Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
| | - Chen Chen
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
| | - Josephine M. Forbes
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
- Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg 3084, Australia
| | - Amelia K. Fotheringham
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
- Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
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Birkebaek NH, Kamrath C, Grimsmann JM, Aakesson K, Cherubini V, Dovc K, de Beaufort C, Alonso GT, Gregory JW, White M, Skrivarhaug T, Sumnik Z, Jefferies C, Hörtenhuber T, Haynes A, De Bock M, Svensson J, Warner JT, Gani O, Gesuita R, Schiaffini R, Hanas R, Rewers A, Eckert AJ, Holl RW, Cinek O. Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries. Lancet Diabetes Endocrinol 2022; 10:786-794. [PMID: 36202118 PMCID: PMC9597608 DOI: 10.1016/s2213-8587(22)00246-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND An increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in children was observed in various diabetes centres worldwide during the COVID-19 pandemic. We aimed to evaluate trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes before and during the COVID-19 pandemic, and to identify potential predictors of changes in diabetic ketoacidosis prevalence during the pandemic. METHODS For this international multicentre study, we used data from 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA [Colorado], and Wales). The study population comprised 104 290 children and adolescents aged 6 months to younger than 18 years, who were diagnosed with type 1 diabetes between Jan 1, 2006, and Dec 31, 2021. The observed diabetic ketoacidosis prevalence in 2020 and 2021 was compared to predictions based on trends over the pre-pandemic years 2006-19. Associations between changes in diabetic ketoacidosis prevalence and the severity of the COVID-19 pandemic and containment measures were examined with excess all-cause mortality in the whole population and the Stringency Index from the Oxford COVID-19 Government Response Tracker. FINDINGS 87 228 children and adolescents were diagnosed with type 1 diabetes between 2006 and 2019, 8209 were diagnosed in 2020, and 8853 were diagnosed in 2021. From 2006 to 2019, diabetic ketoacidosis at diagnosis of type 1 diabetes was present in 23 775 (27·3%) of 87 228 individuals and the mean annual increase in the prevalence of diabetic ketoacidosis in the total cohort from 2006 to 2019 was 1·6% (95% CI 1·3 to 1·9). The adjusted observed prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes was 39·4% (95% CI 34·0 to 45·6) in 2020 and 38·9% (33·6 to 45·0) in 2021, significantly higher than the predicted prevalence of 32·5% (27·8 to 37·9) for 2020 and 33·0% (28·3 to 38·5) for 2021 (p<0·0001 for both years). The prevalence of diabetic ketoacidosis was associated with the pandemic containment measures, with an estimated risk ratio of 1·037 (95% CI 1·024 to 1·051; p<0·0001) per ten-unit increase in the Stringency Index for 2020 and 1·028 (1·009 to 1·047; p=0·0033) for 2021, but was not significantly associated with excess all-cause mortality. INTERPRETATION During the COVID-19 pandemic, there was a marked exacerbation of the pre-existing increase in diabetic ketoacidosis prevalence at diagnosis of type 1 diabetes in children. This finding highlights the need for early and timely diagnosis of type 1 diabetes in children and adolescents. FUNDING German Federal Ministry for Education and Research, German Robert Koch Institute, German Diabetes Association, German Diabetes Foundation, Slovenian Research Agency, Welsh Government, Central Denmark Region, and Swedish Association of Local Authorities and Regions.
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Affiliation(s)
- Niels H Birkebaek
- Department of Pediatrics and Adolescent Medicine and Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
| | - Clemens Kamrath
- Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Karin Aakesson
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC Ljubljana, University Children's Hospital, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg
| | - Guy T Alonso
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Mary White
- Department of Endocrinology and Diabetes, and Health Services Research Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Diabetes Research, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czechia; University Hospital Motol, Prague, Czechia
| | - Craig Jefferies
- Starship Children's Health and University of Auckland, Auckland, New Zealand
| | - Thomas Hörtenhuber
- Department of Pediatrics and Adolescent Medicine, Kepler University Clinic, Linz, Austria
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Martin De Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Jannet Svensson
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Justin T Warner
- Department of Paediatric Endocrinology and Diabetes, Children's Hospital for Wales, Cardiff, UK
| | - Osman Gani
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | | | - Ragnar Hanas
- NU Hospital Group, Uddevalla, Trollhättan, Sweden; Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Arleta Rewers
- Denver Scool of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czechia; University Hospital Motol, Prague, Czechia
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Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 2022; 23:835-856. [PMID: 36250645 DOI: 10.1111/pedi.13406] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Nicole Glaser
- Department of Pediatrics, Section of Endocrinology, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Austria Medical University of Graz, Graz, Austria
| | - Leena Priyambada
- Division of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Arleta Rewers
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Sylvia Estrada
- Department of Pediatrics, Division of Endocrinology and Metabolism, University of the Philippines, College of Medicine, Manila, Philippines
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Reschke F, Lanzinger S, Herczeg V, Prahalad P, Schiaffini R, Mul D, Clapin H, Zabeen B, Pelicand J, Phillip M, Limbert C, Danne T. The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry. Diabetes Care 2022; 45:2594-2601. [PMID: 36166593 DOI: 10.2337/dc22-0278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. RESEARCH DESIGN AND METHODS We analyzed data on 17,280 cases of T1D diagnosed during 2018-2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. RESULTS The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1-12.2) in 2018 to 21.7 (20.6-22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2-14.0) in 2018 to 26.7 (25.7-27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5-12.9) to 24.7 (24.0-25.5) for adolescents ages 12-18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018-2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. CONCLUSIONS The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.
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Affiliation(s)
- Felix Reschke
- Children's Hospital Auf Der Bult, Hannover Medical School, Hannover, Germany.,SWEET e.V., Hannoversche Kinderheilanstalt, Hannover, Germany
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Vivien Herczeg
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Priya Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA.,Stanford Diabetes Research Center, Stanford, CA
| | | | - Dick Mul
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, the Netherlands
| | - Helen Clapin
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Bedowra Zabeen
- Changing Diabetes in Children and Life for a Child, Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders, Dhaka
| | - Julie Pelicand
- Pediatric and Adolescent Diabetes Program, Department of Pediatrics, San Camilo Hospital, San Felipe, Chile.,Medicine School, Universidad de Valparaíso, San Felipe, Chile
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catarina Limbert
- Unit of Paediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Thomas Danne
- Children's Hospital Auf Der Bult, Hannover Medical School, Hannover, Germany.,SWEET e.V., Hannoversche Kinderheilanstalt, Hannover, Germany
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36
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Rahmati M, Keshvari M, Mirnasuri S, Yon DK, Lee SW, Il Shin J, Smith L. The global impact of COVID-19 pandemic on the incidence of pediatric new-onset type 1 diabetes and ketoacidosis: A systematic review and meta-analysis. J Med Virol 2022; 94:5112-5127. [PMID: 35831242 PMCID: PMC9350204 DOI: 10.1002/jmv.27996] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 12/15/2022]
Abstract
Viral infections may increase the risk of developing type 1 diabetes (T1D), and recent reports suggest that Coronavirus Disease 2019 (COVID-19) might have increased the incidence of pediatric T1D and/or diabetic ketoacidosis (DKA). Therefore, this meta-analysis aims to estimate the risk of global pediatric new-onset T1D, DKA, and severe DKA before and after the COVID-19 pandemic. A systematic search of MEDLINE/PubMed, CINAHL, Scopus, and EMBASE was conducted for articles published up to March 2022. A random-effects meta-analysis was performed to compare the relative risk of T1D and DKA among pediatric patients with T1D between the COVID-19 pre-pandemic and pandemic periods. We also compared glucose and HbA1c values in children who were newly diagnosed with T1D before and after the COVID-19 pandemic. The global incidence rate of T1D in the 2019 period was 19.73 per 100 000 children and 32.39 per 100 000 in the 2020 period. Compared with pre-COVID-19 pandemic, the number of worldwide pediatric new-onset T1D, DKA, and severe DKA during the first year of the COVID-19 pandemic increased by 9.5%, 25%, and 19.5%, respectively. Compared with pre-COVID-19 pandemic levels, the median glucose, and HbA1c values in newly diagnosed T1D children after the COVID-19 pandemic increased by 6.43% and 6.42%, respectively. The COVID-19 pandemic has significantly increased the risk of global pediatric new-onset T1D, DKA, and severe DKA. Moreover, higher glucose and HbA1c values in newly diagnosed T1D children after the COVID-19 pandemic mandates targeted measures to raise public and physician awareness.
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Affiliation(s)
- Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human SciencesLorestan UniversityKhoramabadIran
| | - Maryam Keshvari
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human SciencesLorestan UniversityKhoramabadIran
| | | | - Dong K. Yon
- Department of Pediatrics, Kyung Hee University Medical CenterKyung Hee University College of MedicineSeoulRepublic of Korea
| | - Seung W. Lee
- Department of Data ScienceSejong University College of Software ConvergenceSeoulRepublic of Korea
- Sungkyunkwan University School of MedicineSuwonRepublic of Korea
| | - Jae Il Shin
- Department of PediatricsYonsei University College of MedicineSeoulRepublic of Korea
| | - Lee Smith
- Centre for Health, Performance, and WellbeingAnglia Ruskin UniversityCambridgeUK
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Shi Y, Wu LQ, Wei P, Liao ZH. Children with type 1 diabetes in COVID-19 pandemic: Difficulties and solutions. World J Clin Pediatr 2022; 11:408-418. [PMID: 36185098 PMCID: PMC9516491 DOI: 10.5409/wjcp.v11.i5.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/01/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023] Open
Abstract
Children/adolescents with type 1 diabetes (T1D) require holistic approach and continuous care. However, the coronavirus disease 2019 (COVID-19) pandemic has made challenges for the T1D children and their caregivers, professionals, and the healthcare system. This minireview aims to consolidate and discuss the difficulties and solutions of children with type 1 diabetes in the COVID-19 pandemic. T1D has been the most common type of diabetes in children and adolescents and the last decades has seen a rapid increase in the prevalence of T1D in youths worldwide, which deserves a public concern particularly in the COVID-19 pandemic. As reported in previous studies, T1D is a risk factor related to severe cases, while the virus may induce new-onset diabetes and serious complications. Moreover, restriction strategies influence medical availability and lifestyle, impact glycemic control and compilation management, and thus pose stress on families and health providers of youths with T1D, especially on those with certain fragile conditions. Therefore, special treatment plans are required for children provided by caregivers and the local health system. Latest health tools such as improved medical devices and telemedicine service, as well as a combined support may benefit in this period. This minireview emphasises that continued medical access and support are required to prevent deteriorated condition of children and adolescents with diabetes throughout this pandemic. Therefore, strategies are supposed to be formulated to mitigate the difficulties and stress among this group, particularly in the most at-risk population. Proposed solutions in this minireview may help individuals and the health system to overcome these problems and help youths with T1D in better diabetes management during such emergency situations.
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Affiliation(s)
- Yue Shi
- Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Li-Qun Wu
- Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Peng Wei
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Ze-Huan Liao
- School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm 17177, Sweden
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38
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Farakla I, Lagousi T, Miligkos M, Nicolaides N, Vasilakis IA, Mpinou M, Dolianiti M, Katechaki E, Taliou A, Spoulou V, Kanaka-Gantenbein C. Stress hyperglycemia, Diabetes mellitus and COVID-19 infection: The impact on newly diagnosed type 1 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:818945. [PMID: 36992762 PMCID: PMC10012074 DOI: 10.3389/fcdhc.2022.818945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/29/2022] [Indexed: 11/13/2022]
Abstract
Several recent studies have documented an increased incidence of newly diagnosed type 1 Diabetes (T1D) cases in children and adolescents during the COVID-19 pandemic and a more severe presentation at diabetes onset. In this descriptive study, we present the experience of the Diabetes Centre of the Division of Endocrinology, Diabetes, and Metabolism of the First Department of Pediatrics of the National and Kapodistrian University of Athens Medical School at “Aghia Sophia” Children’s Hospital in Athens, Greece, concerning new cases of T1D diagnosis during the COVID-19 pandemic (March 2020- December 2021). Patients who had already been diagnosed with T1D and needed hospitalization due to poor control during the pandemic have been excluded from this study. Eighty- three children and adolescents with a mean age of 8,5 ± 4.02 years were admitted to the hospital due to newly diagnosed T1D during this 22 months’ period in comparison to 34 new cases in the previous year. All patients admitted during the pandemic with a new diagnosis of T1D, presented in their majority with DKA (Ph: 7.2) representing an increase of new severe cases in comparison to previous years (Ph 7.2 versus 7.3, p value: 0.021, in the previous year), [p-value: 0.027]. 49 cases presented with DKA, of which 24 were characterized moderate and 14 severe DKA (28.9% and 16,9%, respectively), while 5 patients newly diagnosed, needed to be admitted to the ICU to recover from severe acidosis. Whether a previous COVID- 19 infection could have been the triggering factor is not supported by the SARS-Cov2 specific antibodies analysis in our cohort of patients. As far as HbA1c is concerned there was no statistically significant difference between the pre COVID-19 year and the years of the pandemic (11.6% versus 11.9%, p- value: 0.461). Triglycerides values were significantly higher in patients with new onset T1D during COVID-19 years compared to those before the pandemic (p value= 0.032). Additionally, there is a statistically significant correlation between Ph and Triglycerides for the whole period 2020-2021 (p-value<0.001), while this correlation is not significant for the year 2019. More large- scale studies are required to confirm these observations.
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Affiliation(s)
- Ioanna Farakla
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Theano Lagousi
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Michael Miligkos
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Nicolas C. Nicolaides
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Ioannis-Anargyros Vasilakis
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Maria Mpinou
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Maria Dolianiti
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Elina Katechaki
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Anilia Taliou
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Vasiliki Spoulou
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
- *Correspondence: Christina Kanaka-Gantenbein,
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39
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Vorgučin I, Savin M, Stanković Đ, Miljković D, Ilić T, Simić D, Vrebalov M, Milanović B, Barišić N, Stojanović V, Vijatov-Đurić G, Koprivšek K, Vilotijević-Dautović G, Antić J. Incidence of Type 1 Diabetes Mellitus and Characteristics of Diabetic Ketoacidosis in Children and Adolescents during the First Two Years of the COVID-19 Pandemic in Vojvodina. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081013. [PMID: 36013479 PMCID: PMC9415410 DOI: 10.3390/medicina58081013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
Background and Objectives: The COVID-19 pandemic has led to significant changes globally, which has also affected patients with type 1 diabetes mellitus (T1DM). This study aimed to determine the incidence of T1DM and the characteristics of diabetic ketoacidosis (DKA) during the pandemic comparing it to pre-pandemic period. Materials and Methods: Data from patients <19 years with newly diagnosed T1DM between 1st January 2017 and 31st December 2021 from four regional centers in Vojvodina were retrospectively collected and analyzed. Results: In 2021, the highest incidence of T1DM in the last five years was recorded, 17.3/100,000. During the pandemic period (2020−2021), there were 99 new-onset T1DM, of which 42.4% presented in DKA, which is significantly higher than in the pre-pandemic period (34.1%). During the pandemic, symptom duration of T1DM lasted significantly longer than before the COVID-19 period. At the age of 10−14 years, the highest incidence of T1DM and COVID-19, the highest frequency rate of DKA, and severe DKA were observed. Conclusions: The pandemic is associated with a high incidence rate of T1DM, longer duration of symptoms of T1DM, a high frequency of DKA, and a severe DKA at diagnosis. Patients aged 10−14 years are a risk group for the occurrence of T1DM with severe clinical presentation. Additional studies are needed with a longer study period and in a wider geographical area, with data on exposure to COVID-19 infection, the permanence of new-onset T1DM, and the psychosocial impact of the pandemic.
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Affiliation(s)
- Ivana Vorgučin
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
- Correspondence: (I.V.); (Đ.S.); Tel.: +381-21-4880-468 (I.V.)
| | - Marijana Savin
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Đurđina Stanković
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Correspondence: (I.V.); (Đ.S.); Tel.: +381-21-4880-468 (I.V.)
| | - Dejan Miljković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Tatjana Ilić
- General Hospital Subotica, 24000 Subotica, Serbia;
| | | | | | - Borko Milanović
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Nenad Barišić
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Vesna Stojanović
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Gordana Vijatov-Đurić
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Katarina Koprivšek
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Gordana Vilotijević-Dautović
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Jelena Antić
- Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia; (M.S.); (B.M.); (N.B.); (V.S.); (G.V.-Đ.); (K.K.); (G.V.-D.); (J.A.)
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
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Leiva-Gea I, Antúnez Fernández C, Cardona-Hernandez R, Ferrer Lozano M, Bahíllo-Curieses P, Arroyo-Díez J, Clemente León M, Martín-Frías M, Conde Barreiro S, Mingorance Delgado A, Pérez Sánchez J. Increased Presentation of Diabetic Ketoacidosis and Changes in Age and Month of Type 1 Diabetes at Onset during the COVID-19 Pandemic in Spain. J Clin Med 2022; 11:4338. [PMID: 35893428 PMCID: PMC9369057 DOI: 10.3390/jcm11154338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 01/08/2023] Open
Abstract
Objective: To assess the impact of the COVID-19 pandemic and lockdown measures on the presenting characteristics (age at diagnosis, severity, monthly distribution) of newly diagnosed type 1 diabetes in Spanish children. Research Design and Methods: An ambispective observational multicenter study was conducted in nine Spanish tertiary-level hospitals between January 2015 and March 2021. Inclusion criteria: new cases of type 1 diabetes in children (0-14 years) recording age, sex, date of diagnosis, presence of diabetic ketoacidosis (DKA) at onset, and severity of DKA. Data were compared before and during the pandemic. Results: We registered 1444 new cases of type 1 diabetes in children: 1085 in the pre-pandemic period (2015-2019) and 359 during the pandemic (2020-March 2021). There was a significant increase in the group aged ≤4 years in the pandemic period (chi-squared = 10.986, df 2, p = 0.0041). In 2020-2021, cases of DKA increased significantly by 12% (95% CI: 7.2-20.4%), with a higher percentage of moderate and severe DKA, although this increase was not significant. In 2020, there was a sharp decrease in the number of cases in March, with a progressive increase from May through November, higher than in the same months of the period 2015-2019, highlighting the increase in the number of cases in June, September, and November. The first three months of 2021 showed a different trend to that observed both in the years 2015-2019 and in 2020, with a marked increase in the number of cases. Conclusions: A change in monthly distribution was described, with an increase in DKA at onset of type 1 diabetes. No differences were found in severity, although there were differences in the age distribution, with an increase in the number of cases in children under 4 years of age.
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Affiliation(s)
- Isabel Leiva-Gea
- Pediatric Endocrinology, Department of Pediatrics, Hospital Regional de Málaga, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | | | - Roque Cardona-Hernandez
- Division of Pediatric Endocrinology, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Barcelona, Spain
| | - Marta Ferrer Lozano
- Pediatric Endocrinology, Department of Pediatrics, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
| | - Pilar Bahíllo-Curieses
- Pediatric Endocrinology, Department of Pediatrics, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Javier Arroyo-Díez
- Pediatric Endocrinology, Department of Pediatrics, Hospital Universitario Materno Infantil de Badajoz, 06010 Badajoz, Spain
| | - María Clemente León
- Pediatric Endocrinology, Department of Pediatrics, Institut de Recerca, Hospital Vall d’Hebron, Centre for Biomedical Research on Rare Diseases (CIBERER), 08035 Barcelona, Spain
- Barcelona Autonomous University, 08035 Barcelona, Spain
| | - Maria Martín-Frías
- Pediatric Endocrinology and Diabetes, Department of Pediatrics, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | | | - Andrés Mingorance Delgado
- Pediatric Endocrinology, Department of Pediatrics, Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Jacobo Pérez Sánchez
- Pediatric Endocrinology, Department of Pediatrics, Consorci Coprporació Sanitaria Parc Tauli, 08208 Sabadell, Spain
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Pietrzak I, Michalak A, Seget S, Bednarska M, Beń‐Skowronek I, Bossowski A, Chobot A, Dżygało K, Głowińska‐Olszewska B, Górnicka M, Horodnicka‐Józwa A, Jakubek‐Kipa K, Jarosz‐Chobot P, Marcinkiewicz K, Mazur A, Myśliwiec M, Nazim J, Niechciał E, Noczyńska A, Rusak E, Seifert M, Skotarczyk‐Kowalska E, Skowronek A, Szypowska A, Wais P, Walczak M, Wołoszyn‐Durkiewicz A, Wysocka‐Mincewicz M, Zubkiewicz‐Kucharska A, Szadkowska A. Diabetic ketoacidosis incidence among children with new-onset type 1 diabetes in Poland and its association with COVID-19 outbreak-Two-year cross-sectional national observation by PolPeDiab Study Group. Pediatr Diabetes 2022; 23:944-955. [PMID: 35700323 PMCID: PMC9350002 DOI: 10.1111/pedi.13379] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are several observations that the onset of coronavirus 19 (COVID-19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country-specific healthcare policies, more national-level evidence is needed to provide generalizable conclusions. OBJECTIVE To compare the rate of DKA in Polish children diagnosed with type 1 diabetes (T1D) between the first year of COVID-19 pandemic (15 March 2020 to 15 March 2021) and the preceding year (15 March 2019 to 15 March 2020). METHODS Reference centers in 13 regions (covering ~88% of Polish children) retrospectively reported all new-onset T1D cases in children from assessed periods, including DKA status at admission, administered procedures and outcomes. Secondly, we collected regions' demographic characteristics and the daily-reported number of COVID-19-related deaths in each region. RESULTS We recorded 3062 cases of new-onset T1D (53.3% boys, mean age 9.5 ± 4.3 years old) of which 1347 (44%) had DKA. Comparing pre- and post-COVID-19 period, we observed a significant increase in the rate of DKA (37.5%-49.4%, p < .0001). The fraction of moderate (+5.4%) and severe (+3.4%) DKA cases increased significantly (p = .0089), and more episodes required assisted ventilation (+2.1%, p = .0337). Two episodes of DKA during 2020/2021 period were fatal. By region, change in DKA frequency correlated with initial COVID-19 death toll (March/April 2020) (R = .6, p = .0287) and change in T1D incidence (R = .7, p = .0080). CONCLUSIONS The clinical picture of new-onset children T1D in Poland deteriorated over a 2-year period. The observed increase in the frequency of DKA and its severity were significantly associated with the overlapping timing of the COVID-19 epidemic.
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Affiliation(s)
- Iwona Pietrzak
- Department of Pediatrics, Diabetology, Endocrinology and NephrologyMedical University of LodzLodzPoland
| | - Arkadiusz Michalak
- Department of Pediatrics, Diabetology, Endocrinology and NephrologyMedical University of LodzLodzPoland,Department of Biostatistics and Translational MedicineMedical University of LodzLodzPoland
| | - Sebastian Seget
- Department of Children's DiabetologyMedical University of SilesiaKatowicePoland
| | - Maria Bednarska
- Department of PediatricsUniversity Clinical Hospital in OpoleOpolePoland
| | - Iwona Beń‐Skowronek
- Department of Pediatric Endocrinology and DiabetologyMedical University in LublinLublinPoland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology and Diabetology with Cardiology UnitMedical University of BialystokBiałystokPoland
| | - Agata Chobot
- Department of PediatricsUniversity Clinical Hospital in OpoleOpolePoland,Department of Pediatrics, Institute of Medical SciencesUniversity of OpoleOpolePoland
| | | | - Barbara Głowińska‐Olszewska
- Department of Pediatrics, Endocrinology and Diabetology with Cardiology UnitMedical University of BialystokBiałystokPoland
| | - Martyna Górnicka
- Department of Endocrinology and DiabetologyChildren's Memorial Health InstituteWarsawPoland
| | - Anita Horodnicka‐Józwa
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental AgePomeranian Medical University in SzczecinSzczecinPoland
| | - Katarzyna Jakubek‐Kipa
- Department of Pediatrics, Pediatric Endocrinology and DiabetesMedical College University of RzeszówRzeszówPoland
| | | | - Katarzyna Marcinkiewicz
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental AgePomeranian Medical University in SzczecinSzczecinPoland
| | - Artur Mazur
- Department of Pediatrics, Pediatric Endocrinology and DiabetesMedical College University of RzeszówRzeszówPoland
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and EndocrinologyMedical University of GdanskGdańskPoland
| | - Joanna Nazim
- Department of Pediatric EndocrinologyJagiellonian University Medical College, Faculty of Medicine, Institute of PediatricsKrakówPoland
| | - Elżbieta Niechciał
- Department of Pediatric Diabetes, Auxology and ObesityPoznan University of Medical SciencesPoznanPoland
| | - Anna Noczyńska
- Department of Pediatric Endocrinology and DiabetologyWroclaw Medical UniversityWroclawPoland
| | - Ewa Rusak
- Department of Children's DiabetologyMedical University of SilesiaKatowicePoland
| | - Monika Seifert
- Department of Pediatric Endocrinology and DiabetologyWroclaw Medical UniversityWroclawPoland
| | | | - Anna Skowronek
- Department of Pediatric Endocrinology and DiabetologyMedical University in LublinLublinPoland
| | | | - Paulina Wais
- Department of Pediatric Diabetes, Auxology and ObesityPoznan University of Medical SciencesPoznanPoland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental AgePomeranian Medical University in SzczecinSzczecinPoland
| | | | | | | | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and NephrologyMedical University of LodzLodzPoland
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Lavik AR, Ebekozien O, Noor N, Alonso GT, Polsky S, Blackman SM, Chen J, Corathers SD, Demeterco-Berggren C, Gallagher MP, Greenfield M, Garrity A, Rompicherla S, Rapaport R, Yayah Jones NH. Trends in Type 1 Diabetic Ketoacidosis During COVID-19 Surges at 7 US Centers: Highest Burden on non-Hispanic Black Patients. J Clin Endocrinol Metab 2022; 107:1948-1955. [PMID: 35380700 PMCID: PMC8992309 DOI: 10.1210/clinem/dgac158] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 12/26/2022]
Abstract
CONTEXT The impact of the COVID-19 pandemic on individuals with type 1 diabetes remains poorly defined. OBJECTIVE We examined United States trends in diabetic ketoacidosis (DKA) among individuals with type 1 diabetes (T1D) during the COVID-19 pandemic at 7 large US medical centers and factors associated with these trends. METHODS We compared DKA events among children and adults with T1D during COVID-19 surge 1 (March-May 2020) and COVID-19 surge 2 (August-October 2020) to the same periods in 2019. Analysis was performed using descriptive statistics and chi-square tests. RESULTS We found no difference in the absolute number of T1D patients experiencing DKA in 2019 vs 2020. However, a higher proportion of non-Hispanic Black (NHB) individuals experienced DKA in 2019 than non-Hispanic White (NHW) individuals (44.6% vs 16.0%; P < .001), and this disparity persisted during the COVID-19 pandemic (48.6% vs 18.6%; P < .001). DKA was less common among patients on continuous glucose monitor (CGM) or insulin pump in 2020 compared to 2019 (CGM: 13.2% vs 15.0%, P < .001; insulin pump: 8.0% vs 10.6%, P < .001). In contrast to annual DKA totals, a higher proportion of patients had DKA during COVID-19 surges 1 and 2 compared to the same months in 2019 (surge 1: 7.1% vs 5.4%, P < .001; surge 2: 6.6% vs 5.7%, P = .001). CONCLUSION DKA frequency increased among T1D patients during COVID-19 surges with highest frequency among NHB patients. DKA was less common among patients using CGM or insulin pumps. These findings highlight the urgent need for improved strategies to prevent DKA among patients with T1D-not only under pandemic conditions, but under all conditions-especially among populations most affected by health inequities.
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Affiliation(s)
- Andrew R Lavik
- Correspondence: Andrew R. Lavik, MD, PhD, Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
| | | | - Nudrat Noor
- T1D Exchange, Boston, Massachusetts 02111, USA
| | - G Todd Alonso
- University of Colorado, Barbara Davis Center for Diabetes, Aurora, Colorado 80045, USA
| | - Sarit Polsky
- University of Colorado, Barbara Davis Center for Diabetes, Aurora, Colorado 80045, USA
| | - Scott M Blackman
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Justin Chen
- SUNY Upstate Medical University, Syracuse, New York 13210, USA
| | - Sarah D Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
| | | | - Mary Pat Gallagher
- Hassenfeld Children’s Hospital at NYU Langone, New York, New York 10016, USA
| | | | - Ashley Garrity
- Division of Pediatric Endocrinology, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | | | - Nana-Hawa Yayah Jones
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
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Mogharab V, Ostovar M, Ruszkowski J, Hussain SZM, Shrestha R, Yaqoob U, Aryanpoor P, Nikkhoo AM, Heidari P, Jahromi AR, Rayatdoost E, Ali A, Javdani F, Farzaneh R, Ghanaatpisheh A, Habibzadeh SR, Foroughian M, Ahmadi SR, Akhavan R, Abbasi B, Shahi B, Hakemi A, Bolvardi E, Bagherian F, Motamed M, Boroujeni ST, Jamalnia S, Mangouri A, Paydar M, Mehrasa N, Shirali D, Sanmarchi F, Saeed A, Jafari NA, Babou A, Kalani N, Hatami N. Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses. Global Health 2022; 18:58. [PMID: 35676714 PMCID: PMC9175527 DOI: 10.1186/s12992-022-00836-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
Background Apart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people’s access or intention to healthcare systems. Objective To compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic. Methods Based on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel. Result There was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients. Conclusions COVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00836-2.
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Affiliation(s)
- Vahid Mogharab
- Department of Pediatrics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mahshid Ostovar
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Jakub Ruszkowski
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,Department of Pathophysiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Rajeev Shrestha
- Palliative Care and Chronic Disease Unit, Green Pasteur Hospital, Pokhara, Nepal
| | - Uzair Yaqoob
- Postgraduate trainee, Surgical Department, Hamdard University Hospital Karachi, Karachi, Pakistan
| | - Poorya Aryanpoor
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Amir Mohammad Nikkhoo
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Parasta Heidari
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Athar Rasekh Jahromi
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Esmaeil Rayatdoost
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Anwar Ali
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Farshid Javdani
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Roohie Farzaneh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aref Ghanaatpisheh
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyed Reza Habibzadeh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayyed Reza Ahmadi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Akhavan
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Abbasi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
| | - Behzad Shahi
- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Arman Hakemi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Bolvardi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Bagherian
- Department of Emergency Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mahsa Motamed
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sheida Jamalnia
- Medical Journalism Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Mangouri
- Fellowship of Vascular Surgery and Endovascular Therapy, Division of Vascular Surgery and Endovascular Therapy, Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Paydar
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Neda Mehrasa
- Shiraz Azad University, Dental Branch, Shiraz, Iran
| | | | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Ayesha Saeed
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Narges Azari Jafari
- Neuroscience Research Department Center, Kashan University of Medical Science, Kashan, Iran
| | - Ali Babou
- Pharmaceutical Sciences Department, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Navid Kalani
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Naser Hatami
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
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Fathi A, Levine GK, Hicks R, Morphew T, Babbitt CJ. Has variable access to health care during the
COVID
‐19 pandemic impacted the severity of paediatric diabetic ketoacidosis? PRACTICAL DIABETES 2022. [PMCID: PMC9347525 DOI: 10.1002/pdi.2394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Alireza Fathi
- Miller Children's and Women's Hospital Long Beach – Pediatrics, Long Beach California United States
| | - Glenn K Levine
- Miller Children's and Women's Hospital Long Beach – Pediatrics, Long Beach California United States
| | - Rebecca Hicks
- Miller Children's and Women's Hospital Long Beach – Pediatrics, Long Beach California United States
- UCLA Mattel Children's Hospital, Los Angeles California United States
| | - Tricia Morphew
- MemorialCare Health System, Fountain Valley California United States
| | - Christopher J Babbitt
- Miller Children's and Women's Hospital Long Beach – Pediatrics, Long Beach California United States
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45
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Lee Y, Kim M, Oh K, Kang E, Rhie YJ, Lee J, Hong YH, Shin YL, Kim JH. Comparison of Initial Presentation of Pediatric Diabetes Before and During the Coronavirus Disease 2019 Pandemic Era. J Korean Med Sci 2022; 37:e176. [PMID: 35668686 PMCID: PMC9171352 DOI: 10.3346/jkms.2022.37.e176] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/04/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hospital visitation has become challenging during the coronavirus disease 2019 pandemic because of quarantine measures and fear of infection. Consequently, newly diagnosed patients may present with more severe diseases during the pandemic. The present study analyzed the differences in the initial clinical presentations of newly diagnosed patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), comparing pre-pandemic and pandemic periods. METHODS Newly diagnosed patients with T1D or T2D and aged < 18 years during 2018-2020 were included in the study. Data were collected retrospectively from four academic centers in Gyeonggi-do, South Korea. Initial clinical data were compared between the pre-pandemic (2018-2019) and pandemic (2020) periods. RESULTS In the pre-pandemic and pandemic periods, 99 patients (41 T1D and 58 T2D patients) and 84 patients (51 T1D and 33 T2D patients) were identified, respectively. During the pandemic, the proportion of diabetic ketoacidosis (DKA) cases increased compared to the pre-pandemic period (21.2% during 2018-2019 vs. 38.1% in 2020; P = 0.012). In the pre-pandemic and pandemic periods, initial pH was 7.32 ± 0.14 and 7.27 ± 0.15, respectively (P = 0.040), and HbA1c values were 11.18 ± 2.46% and 12.42 ± 2.87%, respectively (P = 0.002). During the pandemic, there was an increased risk of DKA in patients with T1D (odds ratio, 2.42; 95% confidence interval, 1.04-5.62; P = 0.040). CONCLUSION During the pandemic, the proportion of DKA in newly diagnosed patients with T1D increased and clinical parameters showed a deteriorating pattern. Increased awareness of pediatric diabetes, especially DKA, could facilitate visit to the hospital for an early diagnosis; thus, reducing the number of DKA cases during the pandemic era.
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Affiliation(s)
- Yoonha Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Minseung Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyeongeun Oh
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Eungu Kang
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young-Lim Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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46
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Lah Tomulić K, Matko L, Verbić A, Milardović A, Severinski S, Kolić I, Baraba Dekanić K, Šerifi S, Butorac Ahel I. Epidemiologic Characteristics of Children with Diabetic Ketoacidosis Treated in a Pediatric Intensive Care Unit in a 10-Year-Period: Single Centre Experience in Croatia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:638. [PMID: 35630055 PMCID: PMC9143855 DOI: 10.3390/medicina58050638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. Materials and Methods: This retrospective study was performed in the PICU, Clinical Hospital Centre Rijeka, in Croatia. All children diagnosed with DKA from 2011-2020 were included in this study. Data were received from hospital medical documentation and patient paper history. The number of new cases and severity of DKA were identified and classified using recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: In this investigation period, 194 children with newly diagnosed T1D were admitted to our hospital: 58 of them were treated in the PICU due to DKA; 48 had newly diagnosed T1D (48/58); and ten previously diagnosed T1D (10/58). DKA as the initial presentation of T1D was diagnosed in 24.7% (48/194). Moderate or severe dehydration was present in 76% of the children at hospital admission. Polyuria, polydipsia, and Kussmaul breathing were the most common signs. Three patients (5.2%) developed cerebral edema, of whom one died. Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.
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Affiliation(s)
- Kristina Lah Tomulić
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Lucija Matko
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Arijan Verbić
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
| | - Ana Milardović
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Srećko Severinski
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Ivana Kolić
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Kristina Baraba Dekanić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Senada Šerifi
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Ivona Butorac Ahel
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
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47
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Nguyen KT, Xu NY, Zhang JY, Shang T, Basu A, Bergenstal RM, Castorino K, Chen KY, Kerr D, Koliwad SK, Laffel LM, Mathioudakis N, Midyett LK, Miller JD, Nichols JH, Pasquel FJ, Prahalad P, Prausnitz MR, Seley JJ, Sherr JL, Spanakis EK, Umpierrez GE, Wallia A, Klonoff DC. Continuous Ketone Monitoring Consensus Report 2021. J Diabetes Sci Technol 2022; 16:689-715. [PMID: 34605694 PMCID: PMC9294575 DOI: 10.1177/19322968211042656] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article is the work product of the Continuous Ketone Monitoring Consensus Panel, which was organized by Diabetes Technology Society and met virtually on April 20, 2021. The panel consisted of 20 US-based experts in the use of diabetes technology, representing adult endocrinology, pediatric endocrinology, advanced practice nursing, diabetes care and education, clinical chemistry, and bioengineering. The panelists were from universities, hospitals, freestanding research institutes, government, and private practice. Panelists reviewed the medical literature pertaining to ten topics: (1) physiology of ketone production, (2) measurement of ketones, (3) performance of the first continuous ketone monitor (CKM) reported to be used in human trials, (4) demographics and epidemiology of diabetic ketoacidosis (DKA), (5) atypical hyperketonemia, (6) prevention of DKA, (7) non-DKA states of fasting ketonemia and ketonuria, (8) potential integration of CKMs with pumps and automated insulin delivery systems to prevent DKA, (9) clinical trials of CKMs, and (10) the future of CKMs. The panelists summarized the medical literature for each of the ten topics in this report. They also developed 30 conclusions (amounting to three conclusions for each topic) about CKMs and voted unanimously to adopt the 30 conclusions. This report is intended to support the development of safe and effective continuous ketone monitoring and to apply this technology in ways that will benefit people with diabetes.
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Affiliation(s)
| | - Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | - Trisha Shang
- Diabetes Technology Society,
Burlingame, CA, USA
| | - Ananda Basu
- University of Virginia,
Charlottesville, VA, USA
| | | | | | - Kong Y. Chen
- National Institute of Diabetes and
Digestive and Kidney Diseases, Bethesda, MD, USA
| | - David Kerr
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Elias K. Spanakis
- Baltimore Veterans Affairs Medical
Center, Baltimore, MD, USA
- University of Maryland, Baltimore,
MD, USA
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48
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Koripalli M, Giruparajah M, Laur C, Shulman R. Selecting an intervention to prevent ketoacidosis at diabetes diagnosis in children using a behavior change framework. Pediatr Diabetes 2022; 23:406-410. [PMID: 35001490 DOI: 10.1111/pedi.13314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/31/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The rate of diabetic ketoacidosis (DKA), a preventable, life-threatening complication of diabetes, at the time of diagnosis in children remains unacceptably high worldwide. We describe our initial approach to selecting a national DKA prevention strategy, to be implemented by the Canadian Pediatric Endocrine Group DKA Prevention Working Group, informed by a framework for behavior change interventions. METHODS Existing interventions were identified from a systematic review and our own gray literature search. We then characterized interventions using the Behavior Change Wheel, a framework to inform and drive behavior change, and matched interventions to behavioral targets, audiences, and identified barriers and facilitators. Feedback from the CPEG DKA prevention working group was incorporated into the intervention plan. RESULTS We identified 27 interventions. Our proposed target behaviors are: (1) prompt recognition of symptoms of diabetes in children; (2) urgent attendance to medical care with a request for an office-based test for diabetes; and (3) rapid confirmation of diagnosis and urgent consultation with pediatric diabetes experts. We initially identified four possible intervention functions including education, training, environment restructuring, and enablement. Feedback from the working group favored education intervention functions including symptom recognition messages targeting parents, caregivers, teachers, and providers and messages about how to make a rapid diagnosis and need for urgent referral targeting providers. CONCLUSIONS The Behavior Change Wheel has been used successfully in selecting interventions in other clinical areas. We describe how we used this framework to provide a foundation for developing an intervention to prevent DKA at diabetes diagnosis in children.
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Affiliation(s)
- Maanasa Koripalli
- Child Health Evaluative Services, Sickkids Research Institute, Toronto, Ontario, Canada
| | - Mohana Giruparajah
- Child Health Evaluative Services, Sickkids Research Institute, Toronto, Ontario, Canada
| | - Celia Laur
- Women's College Hospital, Institute for Health System Solutions and Virtual Care (WIHV), Toronto, Ontario, Canada
| | - Rayzel Shulman
- Child Health Evaluative Services, Sickkids Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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49
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Kamrath C, Rosenbauer J, Eckert AJ, Ohlenschläger U, Sydlik C, Nellen‐Hellmuth N, Holl RW. Glycated hemoglobin at diagnosis of type 1 diabetes and at follow-up in children and adolescents during the COVID-19 pandemic in Germany. Pediatr Diabetes 2022; 23:749-753. [PMID: 35366047 PMCID: PMC9115394 DOI: 10.1111/pedi.13338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study investigated the diagnostic delay and the subsequent quality of care during the Covid-19 pandemic among children with new-onset type 1 diabetes. METHODS We compared the HbA1c levels of 3111 children at diagnosis of type 1 diabetes and of 2825 children at a median follow-up of 4.7 months (interquartile range, 4.1-5.4) together with their daily insulin requirement during the Covid-19 pandemic with the two previous years via multivariable linear regression, using data from the German Diabetes Registry DPV. RESULTS During the Covid-19 pandemic, HbA1c levels were higher at diagnosis of type 1 diabetes (mean estimated difference, 0.33% [95% confidence interval, 0.23-0.43], p < 0.001), but not at follow-up (mean estimated difference, 0.02% [-0.02-0.07]). Children with diabetes onset during the Covid-19 pandemic had a significantly higher daily insulin requirement after initiation of therapy (mean estimated difference, 0.08 U/kg [0.06-0.10], p < 0.001). Both the increase in HbA1c and daily insulin requirement were evident only after the first wave of the pandemic. CONCLUSIONS This increase in HbA1c at diagnosis of type 1 diabetes during the Covid-19 pandemic may indicate a delay in seeking medical care due to the pandemic. However, this did not affect short-term glycemic control. The increased insulin requirement at follow-up could suggest a more rapid autoimmune progression during the pandemic.
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Affiliation(s)
- Clemens Kamrath
- Center of Child and Adolescent MedicineJustus Liebig UniversityGiessenGermany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes CenterLeibniz Center for Diabetes Research at Heinrich Heine University DusseldorfDusseldorfGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Alexander J. Eckert
- German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany,Institute of Epidemiology and Medical Biometry, ZIBMTUlm UniversityUlmGermany
| | - Ute Ohlenschläger
- Child and Adolescent DiabetologyAltonaer KinderkrankenhausHamburgGermany
| | - Carmen Sydlik
- Center of Child and Adolescent MedicineInnklinikum AltöttingAltöttingGermany
| | | | - Reinhard W. Holl
- German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany,Institute of Epidemiology and Medical Biometry, ZIBMTUlm UniversityUlmGermany
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50
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Gaba R, Balasubramanyam A. Covid-19: A new cause of "provoked" A-β+ Ketosis-Prone Diabetes. J Diabetes Complications 2022; 36:108147. [PMID: 35153127 PMCID: PMC8820105 DOI: 10.1016/j.jdiacomp.2022.108147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Ruchi Gaba
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, United States of America.
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, United States of America.
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