Alarming increase in ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the first wave of the COVID ‐19 pandemic in Israel

Abstract

Objective: To evaluate the incidence and severity of ketoacidosis (DKA) at type 1 diabetes diagnosis during the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Israel. Research Design and Methods: A population-based study the product of a national collaboration of Israeli pediatric diabetes centers investigated the presentation of childhood-onset type 1 diabetes. The frequencies of DKA and severe DKA observed during the COVID-19 period from March 15, 2020 (commencement of the first nationwide lockdown) until June 30, 2020 were compared with the same periods in 2019, 2018, and 2017 using multivariable logistic regression, adjusting for age, sex, and socioeconomic position.

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

“…Data regarding the number of children infected by COVID‐19 among all new‐onset T1D were limited as 10 studies did not report any information about the number of diagnosed COVID‐19 patients. 12 , 14 , 18 , 20 , 30 , 32 , 37 , 38 , 40 , 46 The number of COVID‐19‐positive cases in 16 remaining studies was as follows: one case in three studies, 33 , 35 , 42 two cases in two studies, 29 , 36 four cases in two studies, 17 , 45 eight cases in four studies, 13 , 19 , 31 , 41 and no case in five studies. 16 , 34 , 39 , 43 , 44 The worldwide incidence rate of diagnosis of T1D in the 2019 period was 19.73 per 100 000 children (18 years and younger) and 32.39 per 100 000 in the 2020 period.…”

“…Twenty‐four studies 12 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 involving 5671 new T1D patients (2706 new T1D patients in 2019 and 2965 new T1D patients in 2020) reported numbers of pediatric new‐onset T1D before and after the COVID‐19 pandemic. Overall, the COVID‐19 pandemic was significantly associated with an increase in the number of worldwide pediatric newly diagnosed T1D (logit ER = 0.080, 95% confidence interval [CI] 0.028–0.133, p = 0.003; Figure 2A ).…”

“…Twenty‐one studies 12 , 13 , 14 , 16 , 18 , 19 , 20 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 involving 2648 new T1D patients with DKA and 979 new T1D patients with severe DKA (DKA: 1177 new cases in 2019 and 1471 new cases in 2020; severe DKA: 446 new cases in 2019 and 533 new cases in 2020) were included. The random‐effect model showed that COVID‐19 pandemic was associated with an elevation in the risk incidence of worldwide pediatric DKA and severe DKA compared with pre‐COVID‐19 period (RR = 0.064, 95% CI 0.043– 0.084, p = 0.0001, and RR, 0.049 (95% CI: 0.029–0.066; p = 0.0001, respectively; Figure 3 ).…”

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

“…The systematic search yielded 372 citations, and 20 studies met the inclusion criteria (Figure 1) (10)(11)(12)(13)(14)(15)(16)(17)(18)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). These studies included 37,174 patients with type 1 diabetes in the prior-to-COVID-19 pandemic group and 27,812 patients in the during-COVID-19 group.…”

Diabetic ketoacidosis incidence among children with new‐onset type 1 diabetes in Poland and its association with COVID ‐19 outbreak—Two‐year cross‐sectional national observation by PolPeDiab Study Group

“…The first reports covering 1st wave of COVID‐19 pandemic were highly variable and included no change in DKA frequency (Italy) or increasing tendencies—some of which did (Germany, Israel, Saudi Arabia, United Kingdom 16 , 17 , 18 , 23 , 24 , 27 ) or did not reach statistical significance (United States). 28 Moreover, the noted increase was not always upheld—for example, in the United States it encompassed only first 6 weeks of COVID‐19 pandemic.…”