The Impact of SARS-CoV-2 Pandemic on the New Cases of T1DM in Children. A Single-Centre Cohort Study

Abstract

Type 1 diabetes mellitus (T1DM) represents one of the most frequent chronic illnesses affecting children. The early diagnosis of this disease is crucial, as it plays a key role in preventing the development of a life-threatening acute complication: diabetic ketoacidosis. The etiopathogenetic role of viral infections has long been suggested and emerging data are pointing towards a complex bidirectional relationship between diabetes and COVID-19. The aim of this study is to assess the impact of the COVID-19 pandemic on the incidence and severity of new T1DM cases in children in Romania. We analyzed the differences between a group of 312 patients diagnosed with T1DM in the period 2003–2019 and a group of 147 children diagnosed during the pandemic. The data were investigated using statistical analysis of a series of relevant variables. The total number of newly diagnosed T1DM increased by 30.08% in the period March 2020–February 2021 compared to the previous years. The patients in the pandemic group had a higher mean age at the onset of T1DM, were less frequently living in an urban area, and presented a higher mean value of HbA1c. Diabetic ketoacidosis at the onset of T1DM was 67.40% more frequent, and a higher percentage of these patients presented with a severe form. The duration of T1DM symptoms did not differ significantly between the two groups. A number of 8 patients associated SARS-CoV-2 infection at the time of T1DM diagnosis.

Has the COVID-19 Pandemic Affected the Prevalence of Diabetic Ketoacidosis in Polish Children with Newly Diagnosed Type 1 Diabetes? An Example of the Largest Polish Pediatric Diabetes Center (Upper Silesia—Katowice, Poland)

“…The average level of HbA1c in our study was higher in 2020 compared to 2019 in a statistically significant manner. The same observations were also seen in many other countries [ 31 , 32 , 35 , 36 ]. Venous blood pH was, in most of the cited publications, a criterion for the diagnosis of DKA.…”

“…Researchers at the Romanian reference center for children with T1D compared two groups of children newly diagnosed with T1D. The first group of children were diagnosed between March 2020 and February 2021, while the second were diagnosed between 2003 and 2019 [ 32 ]. As in most of the publications cited so far, the incidence of DKA in the Romanian study increased from 39.42% (in the pre-pandemic group) to 65.99% (in the pandemic group).…”

“…During the pandemic, this rate was significantly lower than in the pre-COVID-19 periods. Although this decrease was not statistically significant in every case, the trend towards lower pH during the pandemic was noticeable [ 30 , 31 , 32 , 35 ].…”

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

“…For those newly diagnosed with type 1 diabetes presenting with DKA, it is hypothesized that delay in seeking medical help will be preceded by a longer duration of type 1 diabetes symptoms. However, several studies have reported that the duration of symptoms during the pandemic were comparable to duration prior to COVID-19 ( 11 , 17 , 28 , 40 ). This finding suggests that the delay in diagnosing type 1 diabetes is not the only cause for an increased risk of DKA.…”

“…Boboc et al. reported a 30% overall increase in incidences of type 1 diabetes between March 2020 and February 2021 ( 11 ). Interestingly, incidences were found to be lower during the early weeks of the pandemic (March to April 2020).…”