Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

Birkebæk, Niels H; Kamrath, Clemens; Grimsmann, Julia M.; Aakesson, Karin; Cherubini, Valentino; Dovč, Klemen; Beaufort, Carine de; Alonso, G. Todd; Gregory, John Welbourn; White, Mary; Skrivarhaug, Torild; Šumnı́k, Zdenĕk; Jefferies, Craig; Hörtenhuber, Thomas; Haynes, Aveni; Bock, Martin de; Svensson, Jannet; Warner, Justin; Gani, Osman; Gesuita, Rosaria; Schiaffini, Riccardo; Hanås, Ragnar; Rewers, Arleta; Eckert, Alexander J.; Holl, Reinhard W.; Cinek, Ondřej

doi:10.1016/s2213-8587(22)00246-7

Cited by 56 publications

(55 citation statements)

References 26 publications

(37 reference statements)

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“…A recent international multicenter study, based on data from 13 national diabetes registries, reported an observed prevalence of diabetic ketoacidosis (DKA) at diagnosis of T1DM higher than the predicted prevalence in 2020 and 2021, in people < 18 years old. But the observed prevalence was not significantly increased in all countries included in this study [8] .…”

Section: Introductioncontrasting

confidence: 52%

Incidence of new-onset type 1 diabetes during Covid-19 pandemic: A French nationwide population-based study

Mariet

PETIT

Benzenine

et al. 2023

Diabetes & Metabolism

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Section: Introductioncontrasting

confidence: 52%

Incidence of new-onset type 1 diabetes during Covid-19 pandemic: A French nationwide population-based study

Mariet

PETIT

Benzenine

et al. 2023

Diabetes & Metabolism

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“…However, they did not find significant differences by sex or age. 20 Although the evidence suggests that the SARS-CoV-2 pandemic has raised the incidence of T1DM, DKA, and severe DKA, information about the impact of COVID-19 on other clinical outcomes is scarce. Thus, we aimed to determine the impact of this pandemic on the probability of developing pediatric T1DM, DKA, severe DKA, DKA in newly diagnosed and established T1DM, ICU admissions, DKA complications, length of hospitalization stay, and mortality due to DKA.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the incidence and clinical outcomes of diabetic ketoacidosis among male and female children with type 1 diabetes: systematic review and meta-analysis

et al. 2023

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Background: Some studies suggest that the SARS-CoV-2 pandemic increased the incidence of type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA). However, the impact of this pandemic on pediatric T1DM is still mostly unknown. Therefore, we aimed to assess the effect of the COVID-19 pandemic on clinical outcomes in children with T1DM. Methods: We systematically searched for six databases up to 31 August 2022. We included 46 observational studies, 159,505 children of both sexes with T1DM, and 17,547 DKA events. Results: The COVID-19 pandemic significantly increased, in both sexes, the incidence of 1) DKA (OR 1.68; 95% CI 1.44–1.96), 2) severe DKA (OR 1.84; 95% CI 1.59–2.12), 3) DKA in newly diagnosed T1DM (OR 1.75; 95% CI 1.51–2.03), and 4) ICU admissions (OR 1.90; 95% CI 1.60–2.26). However, we did not find a significant association between this pandemic and 1) the incidence of T1DM, 2) the incidence of DKA in established T1DM, 3) the incidence of KDA complications, 4) the length of hospitalization stay, and 5) mortality. Subgroup analysis showed that the study design and the continent of origin accounted for the heterogeneity. Conclusions: The pandemic SARS-CoV-2 raised, in both sexes, the risk of DKA, severe DKA, DKA de novo, and ICU admissions.

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“…Numerous observational studies have shown that the incidence of pediatric diabetic ketoacidosis (DKA), and specifcally severe DKA, increased during the time period corresponding to the peak of the COVID-19 pandemic [1][2][3][4][5][6][7][8][9]. Tere are sparse data, however, on the frequency of altered mental status or clinically apparent brain injury (CABI), and no signifcant diferences have been reported between the prepandemic and pandemic time periods [3,7].…”

Section: Introductionmentioning

confidence: 99%

Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic

2023

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The incidence of pediatric diabetic ketoacidosis (DKA) increased during the peak of the COVID-19 pandemic. The objective of this study was to investigate whether rates of hyperosmolar therapy administration for suspected clinically apparent brain injury (CABI) complicating DKA also increased during this period as compared to the three years immediately preceding the pandemic and to compare the characteristics of patients with suspected CABI before the pandemic, patients with suspected CABI during the peak of the pandemic, and those with DKA but without suspected CABI during the pandemic. Patients aged ≤18 years presenting with DKA before (March 11, 2017–March 10, 2020) and during the peak of the pandemic (March 11, 2020–March 10, 2021) were identified through a rigorous search of two databases. Predefined criteria were used to diagnose suspected CABI. Biochemical, clinical, and sociodemographic data were collected from a comprehensive review of the electronic medical record. The proportion of patients with DKA who received hyperosmolar therapy was significantly higher ( P = 0.014) during the pandemic compared to the prepandemic period; however, this was only significant among patients with newly diagnosed diabetes. Both groups with suspected CABI had more severe acidosis, lower Glasgow Coma Scale scores, and longer hospital admissions ( P < 0.001 for all) than cases without suspected CABI. During the pandemic, the blood urea nitrogen concentration was significantly higher in patients with suspected CABI than those without suspected CABI, suggesting they were more severely dehydrated. The clinical, biochemical, and sociodemographic characteristics of patients with suspected CABI were indistinguishable before and during the pandemic. In conclusion, administration of hyperosmolar therapy for suspected CABI was more common during the peak of the COVID-19 pandemic, possibly a result of delayed presentation, highlighting the need for increased awareness and early recognition of the signs and symptoms of diabetes and DKA, especially during future surges of highly transmissible infections.

show abstract

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

Cited by 56 publications

References 26 publications

Incidence of new-onset type 1 diabetes during Covid-19 pandemic: A French nationwide population-based study

Incidence of new-onset type 1 diabetes during Covid-19 pandemic: A French nationwide population-based study

Impact of the COVID-19 pandemic on the incidence and clinical outcomes of diabetic ketoacidosis among male and female children with type 1 diabetes: systematic review and meta-analysis

Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic

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