Presentation of newly diagnosed type 1 diabetes in children and young people during COVID-19: a national UK survey

Ng, Sze May; Woodger, Katherine; Regan, Fiona; Soni, Astha; Wright, Neil; Agwu, Juliana Chizo; Williams, E. R.; Timmis, Alison; Kershaw, Melanie; Moudiotis, Christopher; Drew, John H.

doi:10.1136/bmjpo-2020-000884

Cited by 35 publications

(47 citation statements)

References 4 publications

(3 reference statements)

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“…This was evidenced by a lower pH at diagnosis, a higher presenting HbA 1c , and a greater risk of developing DKA and severe DKA. These observations are consistent with other reports documenting the higher rates of DKA in both paediatric and adult patient populations during the first months of the pandemic 7–10,13,14 . Pre‐pandemic, younger children presented more severely compared to older children, and this may relate to the known difficulty with recognizing diabetes symptoms in this age group 15 .…”

Section: Discussionsupporting

confidence: 92%

“…The diagnostic accuracy and availability of defined clinical and biochemical end points permits detailed investigation of the effect of the pandemic on childhood onset type 1 diabetes. Reports show an unusually high proportion of children and young people presenting in diabetic ketoacidosis (DKA) during the pandemic 7–10 . In a nationwide survey of paediatric diabetes centres in the United Kingdom, delayed presentation was noted in 20% of children with newly diagnosed type 1 diabetes 8 .…”

Section: Introductionmentioning

confidence: 99%

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The SARS‐CoV‐2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi‐centre study of the first COVID‐19 wave

et al. 2021

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Objective Children are usually mildly affected by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2, COVID‐19). However, the pandemic has caused collateral damage to those with non‐COVID‐19 diseases. We aimed to determine the impact of the COVID‐19 pandemic on the presentation of newly diagnosed childhood onset type 1 diabetes. Methods This was a cross‐sectional study conducted over a 1‐year period. We compared the severity of presentation of new‐onset type 1 diabetes in children under the age of 18 presenting to the multi‐centre North Central London diabetes network before (1 July 2019 to 22 March 2020) and during (23 March 2020 to 30 June 2020) the first wave of the COVID‐19 pandemic in the United Kingdom. Results Over the 1‐year study period, a total of 30 children presented with new‐onset type 1 diabetes during the pre‐pandemic period and 17 presented during the first COVID‐19 wave. Children presented more frequently in diabetic ketoacidosis (DKA) during the first COVID‐19 wave compared with pre‐pandemic (pre‐pandemic: mild 13%, moderate 6.7%, severe 10%; first COVID‐19 wave: mild 5.9%, moderate 24%, severe 47%; p = 0.002). During the first COVID‐19 wave, DKA presentations in children with a family history of type 1 diabetes were fewer compared to those without a family history (33.3% vs. 100.0%; p = 0.006). Children presenting in severe DKA pre‐pandemic were younger than those not in severe DKA (3.9 years vs. 12.2 years, p < 0.001) but this difference was not significant during the first COVID‐19 wave (10.1 years vs. 11.2 years, p = 0.568). Presenting HbA1c measurement was higher in those presenting during the first COVID‐19 wave (13.0 ± 1.7 vs. 10.4 ± 3.2%; 119 ± 19 vs. 90 ± 35 mmol/mol; p = 0.008). Conclusion The COVID‐19 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes. Whatever the context, young people with suspected new‐onset type 1 diabetes should be referred for urgent clinical review.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The SARS‐CoV‐2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi‐centre study of the first COVID‐19 wave

et al. 2021

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“…The increased incidence of severe DKA amongst patients diagnosed post-lockdown, whilst not significant, is a potential concern. This finding is consistent with the Italian data and with other units in the UK 12,17 . It initially appears to be counter-intuitive when one takes into account the reduction in the TDI and PI post-lockdown.…”

Section: Discussionsupporting

confidence: 93%

“…Similar anxieties had been expressed related to delayed presentation of patients with T1DM. 17 One survey of diabetes units in the UK reported that 20% of children and young people diagnosed with T1DM between 1 March and 30 June 2020 had had a delayed presentation. Reasons for this included fear of contracting SARS-CoV-2 as well as limited access to GP services.…”

Section: Discussionmentioning

confidence: 99%

A multi-centre service evaluation of the impact of the COVID-19 pandemic on presentation of newly diagnosed cancers and type 1 diabetes in children in the UK

Williams

McLean

Liu

et al. 2021

Preprint

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Background: The COVID-19 pandemic led to changes in patterns of presentation to Emergency Departments (ED). Child health professionals were concerned that this could contribute to the delayed diagnosis of life-threatening conditions, including childhood cancer (CC) and type 1 diabetes (T1DM). Our multicentre, UK-based service evaluation assessed diagnostic intervals and disease severity for these conditions. Methods: We collected presentation route, timing and disease severity for children with newly diagnosed CC in three principal treatment centres, and T1DM in four centres between 1st January - 31st July 2020 and the corresponding period in 2019. We assessed the impact of lockdown on total diagnostic interval (TDI), patient interval (PI), system interval (SI) and disease severity. Findings: For CCs and T1DM, the route to diagnosis and severity of illness at presentation were unchanged across all time periods. Diagnostic intervals for CCs during lockdown were comparable to that in 2019 (TDI 4.6, PI 1.1 and SI 2.1 weeks), except for an increased PI in Jan-Mar 2020 (median 2.7 weeks). Diagnostic intervals for T1DM during lockdown were similar to that in 2019 (TDI 16 vs 15 and PI 14 vs 14 days), except for an increased PI in Jan-Mar 2020 (median 21 days). Interpretation: There is no evidence of diagnostic delay or increased illness severity for CC or T1DM, during the first phase of the pandemic across the participating centres. This provides reassuring data for children and families with these life-changing conditions.

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“…On the other hand, another study conducted in Italy between February 20 and April 14 in 2019 and 2020 found no difference in DKA incidence and new-onset T1DM diagnosis; however, an increase in DKA severity was observed ( 10 ). A survey from 88 diabetes centers in the UK between March 1, 2020, and June 30, 2020, showed an increase in the incidence and severity of DKA at diagnosis, and about 20% of the centers have attributed this to delayed presentation, while the incidence of new-onset T1DM diagnosis remained the same ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 Pandemic Lockdown on the Incidence of New-Onset Type 1 Diabetes and Ketoacidosis Among Saudi Children

et al. 2021

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BackgroundOverburdened healthcare systems during the coronavirus disease (COVID-19) pandemic led to suboptimal chronic disease management, including that of pediatric type 1 diabetes mellitus (T1DM). The pandemic also caused delayed detection of new-onset diabetes in children; this increased the risk and severity of diabetic ketoacidosis (DKA). We therefore investigated the frequency of new-onset pediatric T1DM and DKA in Saudi Arabia during the COVID-19 pandemic and compared it to the same period in 2019.MethodsWe conducted a multicenter retrospective cohort study, including patients aged 1–14 years admitted with new-onset T1DM or DKA during the COVID-19 pandemic (March–June 2020) and the same period in 2019. We assessed factors including age, sex, anthropometric measures, nationality, duration of diabetes, diabetes management, HbA1c levels, glycemic control, cause of admission, blood gas levels, etiology of DKA, DKA complications, length of hospital stay, and COVID-19 test status.ResultDuring the lockdown, 106 children, compared with 154 in 2019, were admitted to 6 pediatric diabetes centers. Among the admissions, DKA was higher in 2020 than in 2019 (83% vs. 73%; P=0.05; risk ratio=1.15; 95% confidence interval, 1.04–1.26), after adjusting for age and sex. DKA frequency among new-onset T1DM and HbA1c levels at diagnosis were higher in 2020 than in 2019 (26% vs. 13.4% [P=<0.001] and 12.1 ± 0.2 vs. 10.8 ± 0.25 [P<0.001], respectively). Females and older patients had a higher risk of DKA.ConclusionThe lockdown implemented in Saudi Arabia has significantly impacted children with T1DM and led to an increased DKA frequency, including children with new-onset T1DM, potentially owing to delayed presentation.

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Presentation of newly diagnosed type 1 diabetes in children and young people during COVID-19: a national UK survey

Cited by 35 publications

References 4 publications

The SARS‐CoV‐2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi‐centre study of the first COVID‐19 wave

The SARS‐CoV‐2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi‐centre study of the first COVID‐19 wave

A multi-centre service evaluation of the impact of the COVID-19 pandemic on presentation of newly diagnosed cancers and type 1 diabetes in children in the UK

The Impact of COVID-19 Pandemic Lockdown on the Incidence of New-Onset Type 1 Diabetes and Ketoacidosis Among Saudi Children

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