Impact of Coronavirus Disease 2019 Outbreak on Children and Adolescents with Type 1 Diabetes Mellitus

Abstract

Background: This study aimed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on daily routines and health of patients with type 1 diabetes mellitus (T1DM). Study design: A cross-sectional study. Methods: This study included 98 children and adolescents with type 1 diabetes who were regularly followed up in the Endocrinology outpatient clinic of Besat Hospital, Hamadan, Iran, in 2020. The primary measurements included body mass index, glycemic control, number of hypoglycemic events, number of hospitalizations, as well as bedtime and availability of insulin six months pre and post COVID-19 outbreak. The obtained data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically significant. Results: Out of 98 participants (mean ±SD age: 13.5±49), 51% of the cases were male, and %81.6 of the patients were urban residents. Furthermore, most participants (43.9%) were in the age group of 11-15 years, and the mean ±SD duration of diabetes was 4.64±3.31 years. In addition, 2.04% of the participants developed COVID-19. There was a statistically significant difference among average duration of night sleep (P<0.001), bedtime (P<0.001), time of waking up (P<0.001), amount of insulin intake (P=0.003), daily exercise (P<0.001), and availability of the insulin (P<0.001) before and during COVID-19 crisis. The frequencies of hospitalizations and hypoglycemic events were lower after the COVID-19 outbreak (P=0.005 and P=0.034, respectively). Morning insulin dose was omitted in 22.2% of participants. No differences were found between hemoglobin A1c and daytime sleep pre and post COVID-19 outbreak. Conclusions: The key challenges due to COVID-19 pandemic restrictions for Iranian T1DM patients were the need to take more insulin, lower physical activity, non-availability of insulin, and missed morning insulin dose. However, it is worth mentioning that the patients' blood glucose control did not worsen in this period.

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

“…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 ).…”

“…Stipulated reasons for above observations include potential diabetogenic action of the virus itself, as well as behavioural factors such as avoidance of hospital visits, and logistic factors such as overload of the healthcare system during the pandemic [24*] , [26] , [27] , [34] , [51] , [52] . Three studies highlighted that the incidence of hypoglycaemic events as well as hospitalization with hypoglycaemia were low during the lockdown period [19] , [30] , [44] , and one of those studies reported that this reversed after lifting of the lockdown [44] .…”

Evaluation of oral health‐related quality of life in children with acute lymphocytic leukemia/acute myelocytic leukemia: A cross‐sectional study

“…DMFT/dmft has been used to determine oral health in children and adults with type 1 diabetes mellitus (Rafatjou et al, 2016), HIV‐positive adults, and children receiving antineoplastic treatment (Wang et al, 2020), as well as in various conditions, such as fetal alcohol syndrome (Blanck‐Lubarsch et al, 2019), ALL, and ALL/AML (Dubey et al, 2018), orthodontic anomalies (Kukletova et al, 2012), and prosthodontic problems (Zhang et al, 2007). It has also been evaluated according to the presence of a short dental arch (Zhang et al, 2007), high sugar intake (Hong et al, 2018), and tooth brushing habits (Gibson & Williams, 1999).…”

Covid 19 and diabetes in children: advances and strategies

“…A cross-sectional study involving 98 children and adolescents with T1D identified several key challenges faced by Iranian patients due to pandemic restrictions. These challenges included the necessity for increased insulin doses, reduced physical activity, insulin shortages, and missed morning insulin doses [ 30 ]. Other studies also noted weight gain, a significant rise in HbA1c levels, and an increase in daily insulin requirements among children with T1D during the pandemic [ 31 , 32 ].…”