Changes in cardiovascular risk factors among children and young adults with type 1 diabetes during the COVID‐19 pandemic compared to previous years—Results from the German DPV registry

Abstract

Background The diverse stages of the COVID‐19 pandemic led to several social circumstances that influenced daily life and health behavior. Purpose To evaluate changes in cardiovascular risk factors and physical activity among children and young adults with type 1 diabetes (T1D) during the COVID‐19 pandemic in Germany compared to previous years. Methods A total of 32 785 individuals aged 6–21 years at baseline with T1D from the German diabetes patient follow‐up (DPV) registry contributed data on 101 484 person‐years between 2016 and 2021. The first treatment year of each individual within this period was considered as baseline. Based on trends from 2016 to 2019, we estimated differences in body mass index‐SD score (BMI‐SDS), blood pressure (BP‐SDS), and lipid levels (non‐high‐density lipoprotein [non‐HDL]) between observed and predicted estimates for the years 2020 and 2021 using linear regression analysis standardized for age, diabetes duration, sex, and migratory background. The proportion doing organized sports and smoking cigarettes was analyzed using multivariable logistic regression models. Results BMI‐SDS increased constantly from 2016 to 2021 without a significant increase above expected values for 2020/2021. Systolic BP‐SDS (difference observed vs. expected with 95% confidence interval, 2020: 0.10 [0.07–0.14], 2021: 0.17 [0.14–0.20]) and non‐HDL (2020: 2.7 [1.3–4.1] mg/dl, 2021: 4.1 [2.7–5.5] mg/dl) were significantly increased (all p < .001) in both pandemic years. The proportion of subjects participating in organized sports was reduced from over 70% in prepandemic years to 35%–65% in diverse stages/waves of the COVID‐19 pandemic. The percentage smoking cigarettes did not change. Conclusions We describe an increase in BP and atherogenic lipid levels coinciding with a reduction in physical activity but no acceleration of the prepandemic increases in BMI‐SDS among young people with T1D during the COVID‐19 pandemic.

Spatiotemporal association between COVID-19 incidence and type 1 diabetes incidence among children and adolescents: a register-based ecological study in Germany

“…However, changes in BMI-Z-scores and physical activity in children, adolescents and young adults with type 1 diabetes documented in the DPV Registry have been investigated in two recent studies. The findings showed a reduction in physical activity but no acceleration of BMI-Z-scores among young people (6-21 years) ( 30 ), or at most a slight acceleration of BMI-Z-scores in prepubertal children only ( 31 ). We believe that adjusting for these possible confounders is unlikely to affect our results seriously.…”

Endocrine manifestations of COVID-19 in children: A scoping review

“…An increased in BMI, increase in screen time, reduction in physical activity was reported among children/ adolescents with diabetes in many studies (see Table 1 ). Further, a large-scale study among children and adolescents with type 1 diabetes in Germany showed increase in prevalence of cardiovascular risk factors during the lockdown period, such as rise in blood pressure level and atherogenic lipid levels [45] .…”

“…We found 33 studies that looked at the effects of COVID-19 on diabetes among children/adolescents ( Table 1 [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24*] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38*] , [39] , [40] , [41] , [42] , [43] , [44] , [45*] , [46] , [47*] ), of which most focused only on those with TID. One study included both T1D and T2D [46] and one T2D [47] ( Table 1 ).…”

Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real‐world data from the German/Austrian DPV registry

“…Additionally, the ratio of TC/HDL and LDL/HDL was calculated. HbA1c values were standardized to the Diabetes Control and Complications Trial reference range of 4.05%–6.05% (20.7–42.6 mmol/mol) using the multiple of the mean transformation method to account for different laboratory methods 15,16 . Hypertension was defined as systolic blood pressure (BP) ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg.…”

“…HbA1c values were standardized to the Diabetes Control and Complications Trial reference range of 4.05%–6.05% (20.7–42.6 mmol/mol) using the multiple of the mean transformation method to account for different laboratory methods. 15 , 16 Hypertension was defined as systolic blood pressure (BP) ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Metabolic syndrome was defined per the International Diabetes Federation Consensus Statement 17 as obesity (BMI ≥30 kg/m 2 , because waist circumference was not available in most individuals) and one of the following: TG >150 mg/dL, HDL <40 mg/dL (males) or <50 mg/dL (females), lipid‐lowering medication, systolic BP ≥130 mm Hg or diastolic BP ≥85 mm Hg, or antihypertensive medication.…”