Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the<scp>COVID</scp>‐19 pandemic

Ho, Josephine; Rosolowsky, Elizabeth; Pacaud, Danièle; Huang, Carol; Lemay, Julie‐Anne; Brockman, Nicole K.; Rath, Mitchell; Doulla, Manpreet

doi:10.1111/pedi.13205

Cited by 84 publications

(102 citation statements)

References 22 publications

(41 reference statements)

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“…Our data support the observation that COVID-19 pandemic has changed many aspects related to the access to medical care, diagnosis, and treatment of many pediatric diseases around the world [5,23]. Regarding T1D, the first emerging lesson that can be drawn from the experiences in the early phase of the pandemic is the importance of not delaying the diagnosis, which resulted in an increased burden on DKA [20,21,[24][25][26][27].…”

Section: Discussionsupporting

confidence: 81%

Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: The double-wave occurrence

Mameli¹,

Scaramuzza²,

Macedoni³

et al. 2021

EClinicalMedicine

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Section: Discussionsupporting

confidence: 81%

Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: The double-wave occurrence

Mameli¹,

Scaramuzza²,

Macedoni³

et al. 2021

EClinicalMedicine

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“…Among people presenting with DKA with newly diagnosed diabetes, the median age was 30 years (IQR 13-51) in the first wave compared with 27 years (13-49) in the prepandemic period (appendix p 3). During the first wave, there were significantly higher proportions of men (64% [95% CI 61-66] vs 59% [56-62]; p=0•0009) and people of non-White ethnicities (23% [21][22][23][24][25][26] vs 19% [17][18][19][20][21][22]; p<0•0001) admitted with DKA than in the prepandemic period (appendix pp 4-6). No substantial differences were observed in the distribution of cases by age category in people with newly diagnosed diabetes.…”

Section: Resultsmentioning

confidence: 99%

Temporal trends in emergency admissions for diabetic ketoacidosis in people with diabetes in England before and during the COVID-19 pandemic: a population-based study

Misra

Barron²,

Vámos

et al. 2021

The Lancet Diabetes & Endocrinology

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Background Diabetic ketoacidosis (DKA) has been reported to be increasing in frequency during the COVID-19 pandemic. We aimed to examine the rates of DKA hospital admissions and the patient demographics associated with DKA during the pandemic compared with in prepandemic years.Methods Using a comprehensive, multiethnic, national dataset, the Secondary Uses Service repository, we extracted all emergency hospital admissions in England coded with DKA from March 1 to June 30, 2020 (first wave of the pandemic), July 1 to Oct 31, 2020 (post-first wave), and Nov 1, 2020, to Feb 28, 2021 (second wave), and compared these with DKA admissions in the equivalent periods in 2017-20. We also examined baseline characteristics, mortality, and trends in patients who were admitted with DKA.Findings There were 8553 admissions coded with DKA during the first wave, 8729 during the post-first wave, and 10 235 during the second wave. Compared with preceding years, DKA admissions were 6% (95% CI 4-9; p<0•0001) higher in the first wave of the pandemic (from n=8048), 6% (3-8; p<0•0001) higher in the post-first wave (from n=8260), and 7% (4-9; p<0•0001) higher in the second wave (from n=9610). In the first wave, DKA admissions reduced by 19% (95% CI 16-21) in those with pre-existing type 1 diabetes (from n=4965 to n=4041), increased by 41% (35-47) in those with pre-existing type 2 diabetes (from n=2010 to n=2831), and increased by 57% (48-66) in those with newly diagnosed diabetes (from n=1072 to n=1681). Compared with prepandemic, type 2 diabetes DKA admissions were similarly common in older individuals and men but were higher in those of non-White ethnicities during the first wave. The increase in newly diagnosed DKA admissions occurred across all age groups and these were significantly increased in men and people of non-White ethnicities. In the post-first wave, DKA admissions did not return to the baseline level of previous years; DKA admissions were 14% (11-17) lower in patients with type 1 diabetes (from n=5208 prepandemic to n=4491), 30% (24-36) higher in patients with type 2 diabetes (from n=2011 to n=2613), and 56% (47-66) higher in patients with newly diagnosed diabetes (from n=1041 to n=1625). During the second wave, DKA admissions were 25% (22-27) lower in patients with type 1 diabetes (from n=5769 prepandemic to n=4337), 50% (44-56) higher in patients with type 2 diabetes (from n=2608 to n=3912), and 61% (52-70) higher in patients with newly diagnosed diabetes (from n=1234 to n=1986).Interpretation Our results provide evidence for differences in the numbers and characteristics of people presenting with DKA during the COVID-19 pandemic compared with in the preceding 3 years. Greater awareness of risk factors for DKA in type 2 diabetes and vigilance for newly diagnosed diabetes presenting with DKA during the COVID-19 pandemic might help mitigate the increased impact of DKA.

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“…Children presenting with new-onset T1D may also be more likely to present in DKA and may have more severe DKA in during the coronavirus pandemic. 47 However, evidence to date suggests that children with T1D and COVID-19 do not have worse disease outcomes than those without diabetes. 48 Children with diabetes have faced unique challenges related to the COVID-19 pandemic, primarily related to widespread closures of schools and daycare centres.…”

Section: Current Evidence Does Not Suggest That Central Hormone Deficiencies Increase Risk Of Acquiring Sars-cov-2 Infectionmentioning

confidence: 99%

“…T1D Exchange data in the paediatric population demonstrated higher A1C, increased risk of hospitalization, non‐Hispanic Black ethnicity and public insurance in children with T1D and COVID‐19 (unpublished data). Children presenting with new‐onset T1D may also be more likely to present in DKA and may have more severe DKA in during the coronavirus pandemic 47 . However, evidence to date suggests that children with T1D and COVID‐19 do not have worse disease outcomes than those without diabetes 48 …”

Section: Sars‐cov‐2 Infection and Complications In Children With Pre‐existing Endocrine Disordersmentioning

confidence: 99%

SARS‐CoV‐2 infection and paediatric endocrine disorders: Risks and management considerations

Ashraf

Gourgari

et al. 2021

Endocrino Diabet & Metabol

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Background Coronavirus‐19 (COVID‐19) is a disease caused by the SARS‐CoV‐2 virus, the seventh coronavirus identified as causing disease in humans. The SARS‐CoV‐2 virus has multiple potential pathophysiologic interconnections with endocrine systems, potentially causing disturbances in glucose metabolism, hypothalamic and pituitary function, adrenal function and mineral metabolism. A growing body of data is revealing both the effects of underlying endocrine disorders on COVID‐19 disease outcome and the effects of the SARS‐CoV‐2 virus on endocrine systems. However, comprehensive assessment of the relationship to endocrine disorders in children has been lacking. Content In this review, we present the effects of SARS‐CoV‐2 infection on endocrine systems and review the current literature on complications of COVID‐19 disease in underlying paediatric endocrine disorders. We provide recommendations on management of endocrinopathies related to SARS‐CoV‐2 infection in this population. Summary and outlook With the surge in COVID‐19 cases worldwide, it is important for paediatric endocrinologists to be aware of the interaction of SARS‐CoV‐2 with the endocrine system and management considerations for patients with underlying disorders who develop COVID‐19 disease. While children and adults share some risk factors that influence risk of complications in SARS‐CoV‐2 infection, it is becoming clear that responses in the paediatric population are distinct and outcomes from adult studies cannot be extrapolated. Evidence emerging from paediatric studies provides some guidance but highlights the need for more research in this area.

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Diabetic ketoacidosis at type 1 diabetes diagnosis in children during theCOVID‐19 pandemic

Cited by 84 publications

References 22 publications

Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: The double-wave occurrence

Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: The double-wave occurrence

Temporal trends in emergency admissions for diabetic ketoacidosis in people with diabetes in England before and during the COVID-19 pandemic: a population-based study

SARS‐CoV‐2 infection and paediatric endocrine disorders: Risks and management considerations

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