Higher rates of diabetic ketoacidosis and admission to the paediatric intensive care unit among newly diagnosed children with type 1 diabetes in Kuwait during the COVID‐19 pandemic

Abstract

Introduction The COVID‐19 pandemic might have a multifaceted effect on children with type 1 diabetes (T1D), either directly through infection itself or indirectly due to measures implemented by health authorities to control the pandemic. Objective To compare data on children newly diagnosed with T1D in Kuwait during the COVID‐19 pandemic to the pre‐pandemic period. Research Design and Methods We analysed data on children aged 12 years or less registered in the Childhood‐Onset Diabetes electronic Registry (CODeR) in Kuwait. Data were incidence rate (IR), diabetic ketoacidosis (DKA), and its severity and admission to the paediatric intensive care unit (PICU). Results The IR of T1D was 40.2 per 100,000 (95% CI; 36.0–44.8) during the COVID‐19 pandemic period and was not statistically different from pre‐pandemic. A higher proportion of incident T1D cases presented with DKA and were admitted to the PICU during the pandemic (52.2% vs. 37.8%: p ˂ 0.001, 19.8% vs. 10.9%; p = 0.002, respectively). The COVID‐19 pandemic was positively associated with presentation of DKA and admission to PICU (AOR = 1.73; 95% CI, 1.13–2.65; p = 0.012, AOR = 2.04; 95% CI, 1.13–3.67; p = 0.018, respectively). Children of families with a positive history for diabetes were less likely to present with DKA and get admitted to the PICU during the COVID‐19 pandemic (AOR = 0.38; 95% CI, 0.20–0.74; p = 0.004, AOR = 0.22; 95% CI, 0.08–0.61; p = 0.004, respectively). Conclusion High rates of DKA at presentation and admission to PICU in incident T1D cases during the COVID‐19 pandemic warrant further studies and effective mitigation efforts through increasing awareness, early detection, and timely intervention.

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

“…Data regarding the number of children infected by COVID‐19 among all new‐onset T1D were limited as 10 studies did not report any information about the number of diagnosed COVID‐19 patients. 12 , 14 , 18 , 20 , 30 , 32 , 37 , 38 , 40 , 46 The number of COVID‐19‐positive cases in 16 remaining studies was as follows: one case in three studies, 33 , 35 , 42 two cases in two studies, 29 , 36 four cases in two studies, 17 , 45 eight cases in four studies, 13 , 19 , 31 , 41 and no case in five studies. 16 , 34 , 39 , 43 , 44 The worldwide incidence rate of diagnosis of T1D in the 2019 period was 19.73 per 100 000 children (18 years and younger) and 32.39 per 100 000 in the 2020 period.…”

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

“…The systematic search yielded 372 citations, and 20 studies met the inclusion criteria (Figure 1) (10)(11)(12)(13)(14)(15)(16)(17)(18)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). These studies included 37,174 patients with type 1 diabetes in the prior-to-COVID-19 pandemic group and 27,812 patients in the during-COVID-19 group.…”

Adherence to the 2015 and 2020 British Society of Paediatric Endocrinology and Diabetes guidelines and outcomes in critically ill children with diabetic ketoacidosis: a retrospective cohort study

“…We also noted that the number of children referred with DKA was far higher in the 12-month period from March 2020 to March 2021, compared with the previous 18-month period, especially in the 10–15 year age group. Whether this is related to the SARS-CoV-2 pandemic is unclear, although previous reports have also highlighted this finding 6 21–23. Contributing factors to this apparent rise in cases may include delayed presentation to paediatric services due to difficulty or reluctance to access healthcare over this period.…”