Glycated hemoglobin at diagnosis of type 1 diabetes and at follow‐up in children and adolescents during the COVID ‐19 pandemic in Germany

Abstract

Background This study investigated the diagnostic delay and the subsequent quality of care during the Covid‐19 pandemic among children with new‐onset type 1 diabetes. Methods We compared the HbA 1c levels of 3111 children at diagnosis of type 1 diabetes and of 2825 children at a median follow‐up of 4.7 months (interquartile range, 4.1–5.4) together with their daily insulin requirement during the Covid‐19 pandemic with the two previous years via multivariable linear regression, using data from the German Diabetes Registry DPV. Results During the Covid‐19 pandemic, HbA 1c levels were higher at diagnosis of type 1 diabetes (mean estimated difference, 0.33% [95% confidence interval, 0.23–0.43], p < 0.001), but not at follow‐up (mean estimated difference, 0.02% [−0.02–0.07]). Children with diabetes onset during the Covid‐19 pandemic had a significantly higher daily insulin requirement after initiation of therapy (mean estimated difference, 0.08 U/kg [0.06–0.10], p < 0.001). Both the increase in HbA 1c and daily insulin requirement were evident only after the first wave of the pandemic. Conclusions This increase in HbA 1c at diagnosis of type 1 diabetes during the Covid‐19 pandemic may indicate a delay in seeking medical care due to the pandemic. However, this did not affect short‐term glycemic control. The increased insulin requirement at follow‐up could suggest a more rapid autoimmune progression during the pandemic.

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

“…The development of diabetic ketoacidosis is thought to be due to delayed diagnosis and initiation of insulin replacement therapy. 6 , 7 A study done in Germany by Kamrath and colleagues 22 suggested that elevated HbA 1c along with an increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in children during the COVID-19 pandemic might be due to a delay in diagnosis and initiation of type 1 diabetes therapy as a result of the pandemic. By contrast, insulin deficiency due to direct destruction of beta cells by SARS-CoV-2 does not seem to play an important role in children with newly diagnosed type 1 diabetes.…”

Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review

“…Data about the prevalence of diabetic ketoacidosis (DKA) are much more concordant in the literature. Several cohort studies [ 91 , 93 , 98 , 102 , 106 , 123 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 ] and two meta-analyses [ 114 , 164 ] report increases in DKA frequency and DKA severity at diagnosis among newly diagnosed T1D patients. A multicenter study, involving 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, the USA (Colorado), and Wales) compared the observed DKA prevalence in children and adolescents in 2020 and 2021 to predictions based on trends over the prepandemic years 2006–2019.…”

Auswirkungen der COVID-19-Pandemie auf die Versorgung von Menschen mit Diabetes mellitus in Deutschland: ein Scoping Review-Update

“…Insgesamt wurden sieben Veröffentlichungen [14,17,18,19,21,29,31] zu sechs Studien zum Thema ambulante Versorgung identifiziert. Diese waren hinsichtlich der Erhebungsmethoden sehr heterogen: Zwei Studien werteten Daten aus der IQVIA-Datenbank [14,17,18], zwei Ergebnisse von Befragungen [21,31] und jeweils eine Daten der Diabetes-Patienten-Verlaufsdokumentation (DPV) [29] bzw. der gesetzlichen Krankenversicherungen (GKV) [19] aus.…”

“…Ein größerer Anteil von Kindern, bei denen der T1D im Jahr 2020 aufgetreten war, hatte im Vergleich zu Kindern, bei denen er in den beiden Jahren davor diagnostiziert worden war, eine DKA. Die erhöhten HbA1c-Werte könnten ein Hinweis auf eine verspätete Inanspruchnahme ärztlicher Leistungen während der Pandemie sein [29]. Die Analyse von GKV-Daten zeigte im 2.…”

“…[9,10,12,13,14,15,19,21,24,25]. Einige wenige Studien untersuchten die Auswirkungen auf das gesamte Jahr 2020 [23,28,29,30] und lediglich eine Studie beschäftigte sich mit der Einhaltung von Kontrolluntersuchungen von Menschen im DMP T1D in der Region Nordrhein im Jahr 2021 [22]. Daneben fand sich auch eine Reihe von Studien, die die Auswirkungen auf die Diabetesversorgung von der Anfangsphase der Pandemie bis Ende 2021 verfolgt hatten [17,18,20,22,23,25,27,28,30,31,32,33,35,37].…”