ESPEYB20 8. Type 1 Diabetes Important for Clinical Practice (5 abstracts)
8.5. 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
Birkebaek NH , Kamrath C , Grimsmann JM , Aakesson K , Cherubini V , Dovc K , de Beaufort C , Alonso GT , Gregory JW , White M , Skrivarhaug T , Sumnik Z , Jefferies C , Hörtenhuber T , Haynes A , De Bock M , Svensson J , Warner JT , Gani O , Gesuita R , Schiaffini R , Hanas R , Rewers A , Eckert AJ , Holl RW & Cinek O
Lancet Diabetes Endocrinol 2022;10(11):786–794.PMID: 36202118
Brief summary: This international multicentre study collected data from 104 290 children and adolescents (6 months-18 years-old), to compare prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) before and during the COVID-19 pandemic. Prevalence of DKA at T1D diagnosis increased from 27.3% pre-pandemic to 39.4% during the pandemic, and the increased trends were associated with the pandemic containment measures.
DKA is a life-threatening condition, which often occurs at the onset of T1D in children and adolescents (1). This multinational study provides convincing data on trends in DKA at T1D diagnosis before and during the COVID-19 pandemic, based on data from over 100 000 young people from 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA [Colorado], and Wales). The pre-COVID prevalence (2009-2016) of DKA at the onset of T1D was 27.3%, with a mean annual increase of 1.6%. Remarkably, it rose to 39.4% in 2020 and 38.9% in 2021. Of note, the prevalence of DKA was associated with the pandemic containment measures, whereas there was no association with the severity of COVID-19 infection in that setting.
These findings highlight how the pandemic exacerbated an already increasing trend in the prevalence in DKA, and this was likely due to delays in seeking medical attention, due to restrictions in place, and fear of contracting COVID-19 infection. However, additional factors, such as the roles of a viral infection in triggering clinically manifested diabetes in susceptible individuals, and/or infection-related insulin resistance/inflammation in precipitating disease onset should also be considered (2). The increasing trends in DKA already pre-pandemic highlight the need of further efforts to improve recognition of the presenting signs/symptoms by individuals, caregivers and healthcare professional, particularly through awareness campaigns (1). These data also support the ongoing discussion on the value of population screening for T1D and associated monitoring and education programs, as an effecting way to prevent rates of DKA and lead to better outcomes (3).
Of note, there is an ongoing debate on whether SARS-CoV2 itself might directly attack pancreatic β-cells, particularly after a very recent systematic review and meta-analysis reported an alarmingly increase (by 16-28%) in the incidence of T1D in the two years following the COVID-19 pandemic (4).
References: 1. Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022;23(7):835–856. 2. Misra S. Rise in diabetic ketoacidosis during the COVID-19 pandemic: several questions remain. Lancet Diabetes Endocrinol. 2022;10(11):763–765. 3. Hummel S, Carl J, Friedl N, et al. Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation. Diabetologia. 2023;10.1007/s00125-023-05953-0. 4. D’Souza D, Empringham J, Pechlivanoglou P, Uleryk EM, Cohen E, Shulman R. Incidence of diabetes in children and adolescents during the COVID-19 Pandemic: A systematic review and meta-analysis. JAMA Network Open. 2023;6(6):e2321281–e2321281.
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ESPE Yearbook of Paediatric Endocrinology
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