Effect of COVID-19 pandemic on presentation and referral patterns of newly diagnosed children with type 1 diabetes in a developing country

Abstract

Background The global spread of coronavirus disease 2019 (COVID-19), had a great impact on patients worldwide, including those with chronic diseases. We aim to study the effect of COVID-19 pandemic on presentation patterns of patients with type 1 diabetes (T1D) in Jordan, as an example a developing country with limited resources. Methods Medical charts were reviewed for patients presented with new-onset T1D to Jordan University hospital during the first year of pandemic and the preceding year. Categorical data were compared using Pearson Chi-Square and Fisher’s exact test. Continuous data were compared using the Independent Sample t-Test. Results A total of 137 children were diagnosed with T1D during the study period, with 60.6% of those children were diagnosed in the pre-pandemic year compared to 39.4% during the first year of pandemic, p-value=0.013. Percentage of patients diagnosed with DKA as first presentation of T1D during the pre-pandemic year was 34.9% compared to 51.9% during the pandemic year, p-value=0.049. Significant differences in family monthly income (p-value=0.006) and paternal education level (p-value=0.036) were found between children with DKA and those without DKA in the pre-pandemic year, but they were not significant during the pandemic year. Conclusions The unprecedented COVID-19 pandemic had affected presentation pattern of newly diagnosed T1D patients, manifested by lower number of children diagnosed with T1D and higher percentage of DKA as first presentation compared to the preceding year. Health care services should be at utmost preparedness for possible future waves and other pandemics.

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

“…In this systematic review and meta-analysis, in 17 studies including 38 149 children and adolescents with newly diagnosed type 1 diabetes, 13, 23, 24, 27, 31, 32, 38, 39, 49-51, 53, 55, 58-60, 63 we found that the incidence rate of type 1 diabetes was 1.14 times higher in the first year and 1.27 times higher in the second year after the onset of the COVID-19 pandemic compared with before the pandemic. In 15 studies including a total of 4324 children and adolescents with DKA, 27,29,36,37,[40][41][42][44][45][46][47]49,50,54,65 we also found that the incidence rate of DKA at diagnosis was 1.26 times higher in the first year after the onset of the COVID-19 pandemic compared with before the pandemic. The magnitude of increase in the incidence rate of type 1 diabetes that we observed after the onset of the pandemic was greater than the expected 3% to 4% annual increase in the incidence rate based on prepandemic temporal trends in Europe.…”

“…Twenty-four studies (57.1%) reported DKA incidence at diagnosis. 3, 5, 6, 8, 9, 12, 14, 18, 19, 22, 25, 27-31, 34, 35, 37, 38, 40, 42, 48, 49 Incident cases of type 1 and type 2 diabetes were reported in 36 studies (85.7%) 12,23,24,[27][28][29][30][31][32][33][35][36][37][38][39][40][41][42][44][45][46][47][48][49][50][51][52][53][54][55][56][58][59][60][61]63 and 9 studies (21.4%), 3,33,34,39,43,45,46,55,62 respectively. Two studies (4.8%) did not distinguish between diabetes types.…”

“…13,57 Thirty-two studies (76.2%) included children only, 3, 12, 13, 23, 24, 27-32, 35-42, 44, 48-53, 56-58, 60, 61, 63 while the rest (10 [23.8%]) included both children and adults. 33,34,43,[45][46][47]54,55,59,62 Twenty-one studies (50.0%) were from Europe, 12, 23, 30-32, 35, 41, 42, 44, 47-53, 56, 58, 59, 61, 63 12 (28.6%) from North America, 3,13,33,34,38,39,43,45,46,54,57,62 7 (16.7%) from Asia, [27][28][29]36,37,40,60 and 1 (2.4%) from Australia 55 ; 1 study (2.4%) 24 included data from multiple countries across different continents. Nine studies (21.4%) reported either the race or ethnicity of the study population, 3,34,39,43,[45][46][47]54,62 Approximately 95% of all diabetes cases were T1D in this population.…”

“…reported socioeconomic status. 29 All included studies were assessed to have an overall risk of bias rating of "some" (eTable 3 in Supplement 1).…”

“…In a random-effects meta-analysis of pooled data from 15 studies (35.7%) including a total of 4324 children and adolescents with DKA, the incidence rate of DKA was higher during the pandemic period compared with the prepandemic period (IRR, 1.26; 95% CI, 1.17-1.36) (Figure 2C). 27,29,36,37,[40][41][42][44][45][46][47]49,50,54,65 Between-study heterogeneity was minimal (I 2 = 0%).…”