Caring for Pediatric Patients with Diabetes amidst the Coronavirus Disease 2019 Storm

Ho, Cindy Wei Li; Ng, Nicholas Beng Hui; Lee, Yung Seng

doi:10.1016/j.jpeds.2020.04.067

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…These patients were tested due to having mild COVID-19 symptoms or because they lived close to a known positive patient. These low numbers seem to support the evidence that children are generally less prone to COVID-19 and have a milder disease course (6,(10)(11)(12).…”

Section: Discussionsupporting

confidence: 58%

Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children?

et al. 2020

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To evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Italy. RESEARCH DESIGN AND METHODS This was a cross-sectional, Web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetic ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between 20 February and 14 April in 2019 and 2020. RESULTS Fifty-three of 68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared with 2019. Among those newly diagnosed patient who presented in a state of DKA, the proportion with severe DKA was 44.3% in 2020 vs. 36.1% in 2019 (P 5 0.03). There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed severe acute respiratory syndrome coronavirus 2. CONCLUSIONS The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any "second wave" requires strategies to educate and reassure parents about timely emergency department attendance for non-COVID-19 symptoms. At its peak, coronavirus disease 2019 (COVID-19) significantly reduced pediatric emergency department (ED) access, most likely due to the fear of infection (1). During the pandemic, the International Society for Pediatric and Adolescent Diabetes received information from its members about several new type 1 diabetes cases or diabetic ketoacidosis (DKA) episodes where hospitalization was delayed due to the closure of non-COVID-19 services (2). There were also concerns that parents had delayed seeking timely medical advice for children with symptoms of diabetes or DKA, resulting in increased numbers of presentations of severe DKA. Based on these anecdotal cases in Italy and other countries (2), we hypothesized that the COVID-19 pandemic might have affected the number of new diabetes diagnoses and the severity of DKA. We therefore conducted a survey to evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the COVID-19 pandemic in Italy compared with the same period in 2019.

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Section: Discussionsupporting

confidence: 58%

Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children?

et al. 2020

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“…This is likely to be due to far more COVID-19 testing performed as the pandemic progressed compared to during the early phase of the pandemic (January-September 2020) and the reopening of schools in many countries. While most pediatric patients with endocrine disorders affected by COVID-19 have asymptomatic or mild symptoms (16) it is important to note that patients with type 1 or type 2 diabetes were not only more likely to suffer from COVID-19 but also experience moderate to severe symptoms, especially when other comorbidities were present (17,18). As a result, the number of patients with diabetes admitted to the ICU also increased compared to our previous survey (9), reaching a higher proportion of centers which reported admission for non-invasive ventilation (15.9%) and intubation and ventilation (9.7%) in comparison to other endocrine conditions in our survey (6% and 3%, respectively).…”

Section: Discussionmentioning

confidence: 99%

The Challenges of Managing Pediatric Diabetes and Other Endocrine Disorders During the COVID-19 Pandemic: Results From an International Cross-Sectional Electronic Survey

et al. 2021

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BackgroundFrequency, dimensions, management, and outcomes of the COVID-19 pandemic in children with endocrine disorders and diabetes were assessed.MethodsA cross-sectional electronic survey was distributed to the global network of endocrine societies. Respondents’ professional and practice profiles, clinic sizes, their country of practice, and the impact of COVID-19 on endocrine diseases were investigated.ResultsRespondents from 131 pediatric endocrine centers in 51 countries across all continents completed the survey. Routine check-ups and education were altered in most pediatric endocrine clinics. Over 20% of clinics experienced a shortage of critical medications or essential supplies. ICU treatment was required for patients with diabetes and COVID-19 in 21.2% of centers. In diabetes, 44% of respondents reported increased diabetic ketoacidosis episodes in newly diagnosed cases and 30% in established cases. Biopsychosocial and behavioral changes were explicitly reported to be occurring among pediatric patients with endocrine disorders.ConclusionsThis large global survey conducted during the COVID-19 pandemic highlights that diabetes is more challenging to manage than any other pediatric endocrine disorder, with an increased risk of morbidity. Psychological distress due to COVID-19 needs to be recognized and addressed. The importance of close contact with healthcare professionals should be emphasized, and medical supplies should be readily available to all patients.

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“…Recent work has revealed that healthcare professionals have been observing an increased incidence of diabetic ketoacidosis in youth [1] , [2] , [3] , possibly attributed to parents avoiding hospital visits due to the concern of potential infection with COVID-19 [3] . Similarly, for individuals living with diabetes, the COVID-19 pandemic is correlated with increased variability in glycemic control and a reduction in physical activity [4] , which may be a result of stay-at-home recommendations.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of telephone and virtual visits for routine pediatric diabetes care during the COVID-19 pandemic

Fung¹,

Irvine²,

Ayub³

et al. 2020

Journal of Clinical & Translational Endocrinology

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Highlights: The COVID-19 pandemic abruptly changed the delivery of pediatric diabetes care. Our clinic has since provided all routine care by telephone and virtual technology. Telephone and virtual visits have impressive usability in this setting. Families want telephone and virtual care to play a significant role in their future.

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Caring for Pediatric Patients with Diabetes amidst the Coronavirus Disease 2019 Storm

Cited by 6 publications

References 8 publications

Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children?

Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children?

The Challenges of Managing Pediatric Diabetes and Other Endocrine Disorders During the COVID-19 Pandemic: Results From an International Cross-Sectional Electronic Survey

Evaluation of telephone and virtual visits for routine pediatric diabetes care during the COVID-19 pandemic

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