Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes

Elgenidy, Anas; Awad, Ahmed K.; Saad, Khaled; Atef, Mostafa; El-Leithy, Hatem Helmy; Obiedallah, Ahmed A.; Hammad, Emad M.; Ahmad, Faisal‐Alkhateeb; Ali, Ahmad M.; Dailah, Hamad Ghaleb; Elhoufey, Amira

doi:10.1038/s41390-022-02241-2

Cited by 30 publications

(27 citation statements)

References 54 publications

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“…In contrast, fewer patients with established T1DM diagnosis had DKA during the pandemic phase. While the reported number of cases for these outcomes were relatively small, the data are consistent with current evidence reporting an increase in DKA and its severity at diagnosis (21,(26)(27)(28)(29)(56)(57)(58). These findings are likely related to delays in seeking care due to concerns about the increased risk in contracting the COVID-19 virus in healthcare facilities, and caregivers abiding by health systems messaging to divert care away from hospitals to prioritize resource utilization for COVID-19 activities (26).…”

Section: Discussionsupporting

confidence: 84%

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

Rajan

Athale²,

Ewusie³

et al. 2022

Front. Pediatr.

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BackgroundThe COVID-19 pandemic led to substantial shifts in pediatric diabetes care delivery to virtual and hybrid models. It is unclear if these changes in care delivery impacted short-term patient outcomes.ObjectivesWe aimed to explore glycemic control and other diabetes-related outcomes in children living with Type 1 Diabetes Mellitus (T1DM) during the first year of the COVID-19 pandemic at a tertiary pediatric academic center in Canada.SubjectsPatients <18 years of age with a confirmed diagnosis of T1DM for at least one year were included.MethodsThis was a retrospective chart review. We compared data from two years pre-pandemic (March 15, 2018–March 14, 2020) to the first year of the pandemic (March 15, 2020–March 14, 2021). The data assessed included glycemic control [Hemoglobin A1c (HbA1c)], diabetic ketoacidosis (DKA), hospital attendance and hospitalizations, hypoglycemia, and hyperglycemia. The generalized estimating equation (GEE) analysis was used to model potential factors affecting the HbA1c and diabetes-related morbidities. Multiple imputations were conducted as a sensitivity analysis.ResultsThere were 346 eligible patients included in the study. The HbA1c remained stable during the pandemic compared to the pre-pandemic phase (MD-0.14, 95% CI, −0.28, 0.01; p = 0.058). The pandemic saw an increase in the number of newly diagnosed patients (X2 = 16.52, p < 0.001) and a higher number of newly diagnosed patients presenting in DKA (X2 = 12.94, p < 0.001). In patients with established diabetes, there was an increase in hyperglycemia (OR1.38, 95% CI, 1.12,1.71; p = 0.003) and reduced DKA (OR 0.30, 95% CI, 0.12,0.73; p = 0.009) during the pandemic compared to the pre-pandemic phase. Stable rates of hospitalization (OR0.57, 95% CI, 0.31,1.04, p = 0.068) and hypoglycemia (OR1.11, 95% CI, 0.83,1.49; p = 0.484) were noted. These results were retained in the sensitivity analysis.ConclusionsGlycemic control in children with T1DM remained stable during the first year of the pandemic. There were more newly diagnosed patients during the pandemic compared to the pre-pandemic phase, and more of these new patients presented in DKA. The latter presentation was reduced in those with established diabetes during the same period.Further studies are needed to assess the ongoing impact of the COVID-19 pandemic on T1DM care pathways and outcomes to allow children, families, and diabetes teams to personalize choices of care models.

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Section: Discussionsupporting

confidence: 84%

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

Rajan

Athale²,

Ewusie³

et al. 2022

Front. Pediatr.

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“…Elgenidy A et al 11 conducted a meta-analysis to investigate the increase of DKA in pediatrics at the time of the SARS-CoV-2 pandemic. In three databases, they looked for papers evaluating the frequency of diabetic ketoacidosis.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Similarly, three systematic reviews and meta-analyses have shown an increase in the risk of developing DKA and severe DKA during the COVID-19 pandemic compared to the pre-pandemic era. [10][11][12] Besides, people with DM are disproportionately affected by COVID-19. For example, they are more susceptible to be admitted to an intensive care unit (ICU) than those non-diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the incidence and clinical outcomes of diabetic ketoacidosis among male and female children with type 1 diabetes: systematic review and meta-analysis

et al. 2023

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Background: Some studies suggest that the SARS-CoV-2 pandemic increased the incidence of type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA). However, the impact of this pandemic on pediatric T1DM is still mostly unknown. Therefore, we aimed to assess the effect of the COVID-19 pandemic on clinical outcomes in children with T1DM. Methods: We systematically searched for six databases up to 31 August 2022. We included 46 observational studies, 159,505 children of both sexes with T1DM, and 17,547 DKA events. Results: The COVID-19 pandemic significantly increased, in both sexes, the incidence of 1) DKA (OR 1.68; 95% CI 1.44–1.96), 2) severe DKA (OR 1.84; 95% CI 1.59–2.12), 3) DKA in newly diagnosed T1DM (OR 1.75; 95% CI 1.51–2.03), and 4) ICU admissions (OR 1.90; 95% CI 1.60–2.26). However, we did not find a significant association between this pandemic and 1) the incidence of T1DM, 2) the incidence of DKA in established T1DM, 3) the incidence of KDA complications, 4) the length of hospitalization stay, and 5) mortality. Subgroup analysis showed that the study design and the continent of origin accounted for the heterogeneity. Conclusions: The pandemic SARS-CoV-2 raised, in both sexes, the risk of DKA, severe DKA, DKA de novo, and ICU admissions.

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“…15,16 In addition to reports of an increased incidence rate of diabetes, there have also been consistent reports of an increased risk of diabetic ketoacidosis (DKA), a preventable and life-threatening condition, at diabetes onset in children during the pandemic. 4,17,18 It is critical to know whether there was a sustained change in the incidence rates of both type 1 and type 2 diabetes in children because there are important implications for health resource planning for pediatric diabetes care, COVID-19-related and future pandemic-related public health measures, and immunization strategies. The primary objective of this systematic review and meta-analysis was to investigate whether there was a change in the incidence rate of types 1 and 2 diabetes in children and adolescents during the COVID-19 pandemic compared with before the pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…It is plausible that the increase in sedentary behavior observed during the COVID-19 pandemic due to school closures and lockdown measures was associated with the increased prevalence of childhood obesity, a known risk factor for type 2 diabetes . In addition to reports of an increased incidence rate of diabetes, there have also been consistent reports of an increased risk of diabetic ketoacidosis (DKA), a preventable and life-threatening condition, at diabetes onset in children during the pandemic …”

Section: Introductionmentioning

confidence: 99%

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

D’Souza,

Empringham,

Pechlivanoglou

et al. 2023

JAMA Netw Open

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ImportanceThere are reports of increasing incidence of pediatric diabetes since the onset of the COVID-19 pandemic. Given the limitations of individual studies that examine this association, it is important to synthesize estimates of changes in incidence rates.ObjectiveTo compare the incidence rates of pediatric diabetes during and before the COVID-19 pandemic.Data SourcesIn this systematic review and meta-analysis, electronic databases, including Medline, Embase, the Cochrane database, Scopus, and Web of Science, and the gray literature were searched between January 1, 2020, and March 28, 2023, using subject headings and text word terms related to COVID-19, diabetes, and diabetic ketoacidosis (DKA).Study SelectionStudies were independently assessed by 2 reviewers and included if they reported differences in incident diabetes cases during vs before the pandemic in youths younger than 19 years, had a minimum observation period of 12 months during and 12 months before the pandemic, and were published in English.Data Extraction and SynthesisFrom records that underwent full-text review, 2 reviewers independently abstracted data and assessed the risk of bias. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Eligible studies were included in the meta-analysis and analyzed with a common and random-effects analysis. Studies not included in the meta-analysis were summarized descriptively.Main Outcomes and MeasuresThe primary outcome was change in the incidence rate of pediatric diabetes during vs before the COVID-19 pandemic. The secondary outcome was change in the incidence rate of DKA among youths with new-onset diabetes during the pandemic.ResultsForty-two studies including 102 984 incident diabetes cases were included in the systematic review. The meta-analysis of type 1 diabetes incidence rates included 17 studies of 38 149 youths and showed a higher incidence rate during the first year of the pandemic compared with the prepandemic period (incidence rate ratio [IRR], 1.14; 95% CI, 1.08-1.21). There was an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the prepandemic period (IRR, 1.27; 95% CI, 1.18-1.37). Ten studies (23.8%) reported incident type 2 diabetes cases in both periods. These studies did not report incidence rates, so results were not pooled. Fifteen studies (35.7%) reported DKA incidence and found a higher rate during the pandemic compared with before the pandemic (IRR, 1.26; 95% CI, 1.17-1.36).Conclusions and RelevanceThis study found that incidence rates of type 1 diabetes and DKA at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.

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Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes

Cited by 30 publications

References 54 publications

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

Impact of the COVID-19 pandemic on the incidence and clinical outcomes of diabetic ketoacidosis among male and female children with type 1 diabetes: systematic review and meta-analysis

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

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