Effectiveness of ketoacidosis prevention campaigns at diagnosis of type 1 diabetes in children: A systematic review and meta-analysis

Cherubini, Valentino; Marino, Mónica; Carle, Flavia; Zagaroli, Luca; Bowers, Renee; Gesuita, Rosaria

doi:10.1016/j.diabres.2021.108838

Cited by 25 publications

(11 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prevention campaigns have proven useful in reducing the prevalence rate of DKA in newly diagnosed children with type 1 diabetes (58-60). Cherubini et al study suggested several actions that can optimize awareness campaigns such as targeting families of children under the age of 15 years, smaller geographic areas and family pediatricians in addition to utilizing innovative communication tools (61). Although public health campaigns might be challenging during pandemics given the public is receiving large amount of health information, they could be useful as a public health tool during such pandemic periods when DKA is on the rise.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies

et al. 2022

View full text Add to dashboard Cite

BackgroundPrevious reports suggest that the Coronavirus Disease-2019 (COVID-19) pandemic might have affected incidences of diabetic ketoacidosis (DKA) and new diagnoses of type 1 diabetes. This systematic review and meta-analysis aimed to estimate the risk of DKA, including severe DKA, during the COVID-19 pandemic versus the prior-to-COVID-19 period among pediatric patients with type 1 diabetes.MethodsPubMed and EMBASE were searched for observational studies investigating the risk of DKA among pediatric patients with type 1 diabetes during the COVID-19 pandemic and the prior-to-COVID-19 period. A random meta-analysis model was performed to estimate the relative risk of DKA during the COVID-19 pandemic compared to before the pandemic. Subgroup analyses were conducted based on the type 1 diabetes status, established or newly diagnosed. In addition, sensitivity analysis was conducted for studies that reported results from adjusted analysis for potential confounders using fixed effect model.ResultsA total of 20 observational studies reported the risk of DKA, of which 18 reported the risk of severe DKA. The risks of DKA and severe DKA were 35% (RR 1.35, 95%CI 1.2-1.53, I2 = 71%) and 76% (RR 1.76, 95%CI 1.33-2.33, I2 = 44%) higher in the during-COVID-19 group compared to the prior-to-COVID-19 group, respectively. Among patients with newly diagnosed type 1 diabetes, the risk of DKA was 44% higher for the during-COVID-19 group compared to the prior-to-COVID-19 group (RR 1.44, 95%CI 1.26-1.65; I2 = 64%). Only two studies reported the risk of DKA among patients with established type 1 diabetes and the cumulative risk was not statistically significant. In the sensitivity analysis, four studies reported an adjusted odds ratio (aOR) of the risk of DKA during COVID-19 compared to the prior-to-COVID-19 period. The fixed estimate from the meta-analysis found an increase in the risk of DKA in the during-COVID-19 group compared to the prior-to-COVID-19 group (aOR 2.04, 95%CI 1.66-2.50).ConclusionsThis study showed that DKA risk, especially the risk of severe DKA, has increased significantly during the pandemic. Healthcare systems must be aware and prepared for such an increase in DKA cases and take all necessary measures to prevent future spikes during the pandemic.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272775, identifier PROSPERO [CRD42021272775].

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies

et al. 2022

View full text Add to dashboard Cite

show abstract

“…posters, explicative letter, newspapers and magazines, mass media spots etc.) in reducing the frequency of DKA at the diagnosis of T1D in children and adolescents and are important tool for pediatricians and others to intervene in a timely manner [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Peculiar characteristics of new-onset Type 1 Diabetes during COVID-19 pandemic

et al. 2022

View full text Add to dashboard Cite

Background The COVID-19 pandemic period is having a strong impact on the management of diabetes as well as other chronic diseases as shown by the most severe clinical presentation at onset. The aim of this study was to evaluate the severity of diabetic ketoacidosis (DKA) in youth with newly diagnosed type 1 diabetes in “Santissima Annunziata Hospital” (Chieti, Italy) during COVID-19 pandemic in comparison to the five previous years. Methods A retrospective population-based incidence study was performed. Data were obtained from hospital records of 172 patients with new onset type 1 diabetes divided into two groups according to the diagnosis: Group I, between January 2015 and February 2020; Group II, between March 2020 and April 2021. Data regarding anthropometric, socio-economic and laboratory test were analyzed. DKA (pH < 7.30) and different severity of the disease (severe pH < 7.10; moderate pH < 7.20, mild pH < 7.30) were evaluated. A Spearman correlation between pH values and the main variables of interest was performed. Results DKA frequency was increased by 19 percentage in Group II compared to Group I (55% vs 36%; P = 0.03) with a significant increased risk of severe DKA cases compared to the previous five years (severe DKA 22.5% vs. 8.4%, P = 0.01). pH values were significantly related with HbA1c, blood glucose and c-peptide values in all groups. In addition, in Group II but not in Group I, pH values correlated with Triglycerides and TG/HDL cholesterol ratio. Conclusions During COVID-19 pandemic the risk of more severe clinical presentation of type 1 diabetes at onset is increased. The correlation with lipid profile might suppose an additional effect of lifestyle changes beside the delay in the diagnosis. Modifications of health care system need to be implemented during this peculiar situation in order to avoid such a relevant complication at onset.

show abstract

“…We reviewed interventions included in a systematic review of DKA prevention campaigns at T1D diagnosis in children. 9 We also conducted a gray literature search using three strategies: 1) advanced Google search, 2) targeted government, hospital, and diabetes-related websites, and 3) consultation with pediatric diabetes experts. Databases were searched using the following keywords "Diabetic approach.…”

Section: Identifying Existing Interventionsmentioning

confidence: 99%

“…We identified 27 interventions, 14 of which were included in the systematic review by Cherubini et al 9 A description of each intervention, including components, barriers, and facilitators, is Table S1. [15][16][17][18][19][20] Key facilitators included collaboration with government departments, and stakeholder engagement (parents, teachers, and healthcare providers).…”

Section: Existing Interventionsmentioning

confidence: 99%

Selecting an intervention to prevent ketoacidosis at diabetes diagnosis in children using a behavior change framework

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Effectiveness of ketoacidosis prevention campaigns at diagnosis of type 1 diabetes in children: A systematic review and meta-analysis

Cited by 25 publications

References 25 publications

Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies

Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies

Peculiar characteristics of new-onset Type 1 Diabetes during COVID-19 pandemic

Selecting an intervention to prevent ketoacidosis at diabetes diagnosis in children using a behavior change framework

Contact Info

Product

Resources

About