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

Rahmati, Masoud; Keshvari, Maryam; Mirnasuri, Shahrzad; Yon, Dong Keon; Lee, Seung Won; Smıth, Lee

doi:10.1002/jmv.27996

Cited by 75 publications

(71 citation statements)

References 62 publications

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“…In contrast, fewer patients with established T1DM diagnosis had DKA during the pandemic phase. While the reported number of cases for these outcomes were relatively small, the data are consistent with current evidence reporting an increase in DKA and its severity at diagnosis (21,(26)(27)(28)(29)(56)(57)(58). These findings are likely related to delays in seeking care due to concerns about the increased risk in contracting the COVID-19 virus in healthcare facilities, and caregivers abiding by health systems messaging to divert care away from hospitals to prioritize resource utilization for COVID-19 activities (26).…”

Section: Discussionsupporting

confidence: 85%

“…Emerging evidence suggests that there may be a rise in the number of children newly diagnosed with T1DM during the pandemic compared to the pre-pandemic phase, although this association has not been universal (27)(28)(29)(30)(31)(32)(33). The data so far also suggest an increase in the number of children presenting in diabetic ketoacidosis (DKA) (26,(34)(35)(36).…”

Section: Introductionmentioning

confidence: 99%

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An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

Rajan

Athale²,

Ewusie³

et al. 2022

Front. Pediatr.

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BackgroundThe COVID-19 pandemic led to substantial shifts in pediatric diabetes care delivery to virtual and hybrid models. It is unclear if these changes in care delivery impacted short-term patient outcomes.ObjectivesWe aimed to explore glycemic control and other diabetes-related outcomes in children living with Type 1 Diabetes Mellitus (T1DM) during the first year of the COVID-19 pandemic at a tertiary pediatric academic center in Canada.SubjectsPatients <18 years of age with a confirmed diagnosis of T1DM for at least one year were included.MethodsThis was a retrospective chart review. We compared data from two years pre-pandemic (March 15, 2018–March 14, 2020) to the first year of the pandemic (March 15, 2020–March 14, 2021). The data assessed included glycemic control [Hemoglobin A1c (HbA1c)], diabetic ketoacidosis (DKA), hospital attendance and hospitalizations, hypoglycemia, and hyperglycemia. The generalized estimating equation (GEE) analysis was used to model potential factors affecting the HbA1c and diabetes-related morbidities. Multiple imputations were conducted as a sensitivity analysis.ResultsThere were 346 eligible patients included in the study. The HbA1c remained stable during the pandemic compared to the pre-pandemic phase (MD-0.14, 95% CI, −0.28, 0.01; p = 0.058). The pandemic saw an increase in the number of newly diagnosed patients (X2 = 16.52, p < 0.001) and a higher number of newly diagnosed patients presenting in DKA (X2 = 12.94, p < 0.001). In patients with established diabetes, there was an increase in hyperglycemia (OR1.38, 95% CI, 1.12,1.71; p = 0.003) and reduced DKA (OR 0.30, 95% CI, 0.12,0.73; p = 0.009) during the pandemic compared to the pre-pandemic phase. Stable rates of hospitalization (OR0.57, 95% CI, 0.31,1.04, p = 0.068) and hypoglycemia (OR1.11, 95% CI, 0.83,1.49; p = 0.484) were noted. These results were retained in the sensitivity analysis.ConclusionsGlycemic control in children with T1DM remained stable during the first year of the pandemic. There were more newly diagnosed patients during the pandemic compared to the pre-pandemic phase, and more of these new patients presented in DKA. The latter presentation was reduced in those with established diabetes during the same period.Further studies are needed to assess the ongoing impact of the COVID-19 pandemic on T1DM care pathways and outcomes to allow children, families, and diabetes teams to personalize choices of care models.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

Rajan

Athale²,

Ewusie³

et al. 2022

Front. Pediatr.

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“…As the COVID-19 pandemic has progressed, there is growing evidence that after the acute phase of the disease, people with COVID-19 can develop lingering sequelae (called "long COVID") that may involve pulmonary and extrapulmonary organ system manifestations, such as diabetes [13]. Follow-up of children with COVID-19 has identified that the incidence of type 1 newly diagnosed diabetes has increased [14]. An unregistered meta-analysis [15] in PROSPERO also found an increased risk of diabetes among adults with long COVID-19, but it has some flaws in the study design which limit the interpretation and applicability of the individual studies' findings.…”

Section: Introductionmentioning

confidence: 99%

Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis

Zhang

Mei

Zhang

et al. 2022

BMC Med

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Background There is growing evidence that patients recovering after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have a variety of acute sequelae including newly diagnosed diabetes. However, the risk of diabetes in the post-acute phase is unclear. To solve this question, we aimed to determine if there was any association between status post-coronavirus disease (COVID-19) infection and a new diagnosis of diabetes. Methods We performed a systematic review and meta-analysis of cohort studies assessing new-onset diabetes after COVID-19. PubMed, Embase, Web of Science, and Cochrane databases were all searched from inception to June 10, 2022. Three evaluators independently extracted individual study data and assessed the risk of bias. Random-effects models estimated the pooled incidence and relative risk (RR) of diabetes compared to non-COVID-19 after COVID-19. Results Nine studies with nearly 40 million participants were included. Overall, the incidence of diabetes after COVID-19 was 15.53 (7.91–25.64) per 1000 person-years, and the relative risk of diabetes after COVID-19 infection was elevated (RR 1.62 [1.45–1.80]). The relative risk of type 1 diabetes was RR=1.48 (1.26–1.75) and type 2 diabetes was RR=1.70 (1.32–2.19), compared to non-COVID-19 patients. At all ages, there was a statistically significant positive association between infection with COVID-19 and the risk of diabetes: <18 years: RR=1.72 (1.19–2.49), ≥18 years: RR=1.63 (1.26–2.11), and >65 years: RR=1.68 (1.22–2.30). The relative risk of diabetes in different gender groups was about 2 (males: RR=2.08 [1.27–3.40]; females: RR=1.99 [1.47–2.80]). The risk of diabetes increased 1.17-fold (1.02–1.34) after COVID-19 infection compared to patients with general upper respiratory tract infections. Patients with severe COVID-19 were at higher risk (RR=1.67 [1.25–2.23]) of diabetes after COVID-19. The risk (RR=1.95 [1.85–2.06]) of diabetes was highest in the first 3 months after COVID-19. These results remained after taking confounding factors into account. Conclusions After COVID-19, patients of all ages and genders had an elevated incidence and relative risk for a new diagnosis of diabetes. Particular attention should be paid during the first 3 months of follow-up after COVID-19 for new-onset diabetes.

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“…Coronavirus infection notably increased mortality in diabetic patients, as shown in a retrospective study including 6014 subjects with diabetes in which those positive for COVID-19 infection were 3.46 times more likely to die than those who tested negative [ 90 ]. Besides, diabetes mellitus is one of the main comorbidities of COVID-19 [ 105 , 106 , 107 ]. It is interesting that, conversely, a new-onset of diabetes with metabolic dysregulation and impaired glucose homeostasis, as well as severe metabolic complications, has been described as a consequence of SARS-CoV-2 infection [ 108 ].…”

Section: Resultsmentioning

confidence: 99%

Role of Dipeptidyl Peptidase-4 (DPP4) on COVID-19 Physiopathology

et al. 2022

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DPP4/CD26 is a single-pass transmembrane protein with multiple functions on glycemic control, cell migration and proliferation, and the immune system, among others. It has recently acquired an especial relevance due to the possibility to act as a receptor or co-receptor for SARS-CoV-2, as it has been already demonstrated for other coronaviruses. In this review, we analyze the evidence for the role of DPP4 on COVID-19 risk and clinical outcome, and its contribution to COVID-19 physiopathology. Due to the pathogenetic links between COVID-19 and diabetes mellitus and the hyperinflammatory response, with the hallmark cytokine storm developed very often during the disease, we dive deep into the functions of DPP4 on carbohydrate metabolism and immune system regulation. We show that the broad spectrum of functions regulated by DPP4 is performed both as a protease enzyme, as well as an interacting partner of other molecules on the cell surface. In addition, we provide an update of the DPP4 inhibitors approved by the EMA and/or the FDA, together with the newfangled approval of generic drugs (in 2021 and 2022). This review will also cover the effects of DPP4 inhibitors (i.e., gliptins) on the progression of SARS-CoV-2 infection, showing the role of DPP4 in this disturbing disease.

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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

Cited by 75 publications

References 62 publications

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis

Role of Dipeptidyl Peptidase-4 (DPP4) on COVID-19 Physiopathology

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