Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting With Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey

Kıral, Eylem; Kırel, Birgül; Havan, Merve; Keskın, Mehmet; Karaoğlan, Murat; Yıldırım, Ahmet; Kangin, Murat; Talay, Mehmet Nur; Urun, Tuba; Altuğ, Ümit; Kesici, Selman; Tufan, Erennur; Kaçmaz, Ebru; Bozan, Gürkan; Azapağası, Ebru; Yazıcı, Mutlu Uysal; Öztürk, Zeynelabidin; Yeşilbaş, Osman; Karagüzel, Gülay; Kaya, Gülay; Barlas, Ulkem; Duyu, Muhterem; Boyraz, Merve; Şevketoğlu, Esra; Akçay, Nihal; Hancılı, Suna; Güven, Ayla; Dursun, Oǧuz; Tekerek, Nazan Ülgen; Ozcifci, Gokçen; Yazici, Pınar; Turanlı, Eda Tahir; Kendirli, Tanıl; Kahveci, Fevzi; Yetimakman, Ayşe Filiz; Çıtak, Agop; Şık, Güntülü; Bingöl, İbrahim; Aygün, Fatih; Durak, Cansu; Yılmaz, Resul; Buğrul, Fuat; Sari, Yusuf; Tekguç, Hakan; Albayrak, Hatice; Yener, Nazik; Ağın, Hasan; Soydan, Ekin; Yıldızdaş, Dinçer; Dilek, Semine Özdemir; Yalindag, Nilufer; Incekoy-Girgin, Feyza; Alacakir, Nuri; Tütüncüler, Filiz; Arslanaoglu, Mehmet Ozgur; AYDIN>, Can; Bilgin, Muzaffer; Şimşek, Enver; Dinleyici, Ener Çağrı

doi:10.3389/fped.2022.926013

Cited by 9 publications

(5 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 17 It was stated that in the first year of the pandemic in Turkey, the frequency of cases admitted to pediatric intensive care units (27 centers) across the country due to severe DKA increased compared to the previous year (70.2% vs. 56.5%). 18 However, it is also stated that this study cannot clearly show the frequency of DKA in all newly diagnosed diabetics, as hospitalizations of wards or admissions with hyperglycemia were not evaluated. 18 In another study where the frequency of DKA was evaluated in the first year of the pandemic in Turkey compared to the previous year, the frequency of severe DKA among hyperglycemia, ketosis, and ketoacidosis admissions was found to be 23%.…”

Section: Discussionmentioning

confidence: 85%

“… 18 However, it is also stated that this study cannot clearly show the frequency of DKA in all newly diagnosed diabetics, as hospitalizations of wards or admissions with hyperglycemia were not evaluated. 18 In another study where the frequency of DKA was evaluated in the first year of the pandemic in Turkey compared to the previous year, the frequency of severe DKA among hyperglycemia, ketosis, and ketoacidosis admissions was found to be 23%. 19 …”

Section: Discussionmentioning

confidence: 85%

See 1 more Smart Citation

Change in the Frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes in the Central Anatolia Region of Turkey over the Years Before and After the Coronavirus Disease 2019 Pandemic: A Single-Center Experience

Koca,

Takcı,

Deniz

et al. 2024

Turkish Archives of Pediatrics

View full text Add to dashboard Cite

Objective: The number of admissions for severe diabetic ketoacidosis (DKA) in children with newly diagnosed type 1 diabetes (T1D) increased during the coronavirus disease 2019 pandemic. We aimed to investigate whether there has been a change in this situation in recent years. Materials and Methods: All children with T1D who were diagnosed in our tertiary hospital between 2019 and 2023 were included. Plasma insulin, C-peptide, hemoglobin A1c (HbA1c), and antibodies against thyroid peroxidase, thyroglobulin, insulin, islet cell, glutamic acid decarboxylase, tissue transglutaminase IgA, and endomysium IgA were measured. Results: The frequency of moderate–severe acidosis at admission, which increased after pandemic period compared to the pre-pandemic period, returns to its previous levels over time but still shows a statistical difference compared to the pre-pandemic period ( P = .012). Age, blood gas pH and HCO 3 level, C-peptide, HbA1c, and length of stay of children at the time of admission were compared year by year (years 2019-2023). No statistical differences were observed ( P = .509, P = .181, P = .069, P = .469, P = .346, P = .946), respectively. A significant difference was observed in venous glucose ( P < .001) and insulin ( P = .001) according to years. Also, no significant difference was found about the degree of acidosis according to age ( P = .334). Conclusion: Although the frequency of DKA in children with newly-diagnosed T1D increased in the first years of the pandemic, it has been decreasing over the years toward pre-pandemic levels. The frequency of DKA is still higher than the pre-pandemic period.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 85%

Change in the Frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes in the Central Anatolia Region of Turkey over the Years Before and After the Coronavirus Disease 2019 Pandemic: A Single-Center Experience

Koca,

Takcı,

Deniz

et al. 2024

Turkish Archives of Pediatrics

View full text Add to dashboard Cite

show abstract

“…In a multicenter study conducted in Saudi Arabia during the COVID-19 pandemic period, no significant difference was found between the HbA1c values of newly diagnosed DMs and diagnosed T1DMs without DKA [ 17 ]. On the other hand, in a multi-center study from Turkiye, it is reported that the frequency of new onset of Turkiye 1 diabetes and severe cases among children was increased and the cause of the increased severe presentation might be related to restrictions related to the pandemic [ 23 ]. Similarly, in some recent studies, it was evaluated that higher HbA1c levels of DKA patients presenting with newly diagnosed T1DM were associated with delayed admission to the hospital due to COVID-19 and the length of insulin-free periods compared to patients with previously-diagnosed.…”

Section: Discussionmentioning

confidence: 99%

Does the severity of diabetic ketoacidosis in children with type 1 diabetes change during the COVID-19 pandemic? A single-center experience from a Pediatric Intensive Care Unit

Varol¹

2022

North Clin Istanbul

View full text Add to dashboard Cite

OBJECTIVE During the COVID-19 pandemic, health-care services for diseases other than COVID-19 were interrupted, and patient referrals to health institutions were postponed due to their fear of being infected with COVID-19. Under this situation, we conducted this study to evaluate the clinical and laboratory findings of COVID-19 in patients with Type 1 Diabetes Mellitus (T1DM) hospitalized in our pediatric intensive care unit (PICU) with the diagnosis of diabetic ketoacidosis (DKA) during the pandemic period, and the impact of the pandemic on these findings. METHODS We retrospectively evaluated 55 children aged from 1 month to 18 years old, diagnosed with DKA, and followed up at Istanbul Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital PICU between April 2020 and December 2021. RESULTS A total of 55 patients with DKA as a complication of T1DM were admitted to the PICU during the COVID-19 pandemic. While there was no significant difference in pH and HCO 3 values between those with newly diagnosed T1DM and those with previously-diagnosed T1DM, the HbA1c ratio of newly diagnosed DMs was significantly higher. Of the 55 patients, 4 were COVID-19 PCR positive, and two patients had COVID-19 antibody positivity. When COVID-19 positive patients were compared with negative patients, no significant difference was found between the hospital stay, glucose, HbA1c, lactate, pH, and HCO 3 values. CONCLUSION Higher HbA1c levels of newly diagnosed patients presenting with DKA may be associated with delayed admission to the health institutions due to COVID-19 and the length of insulin-free periods compared to pre-diagnosed patients with T1DM. In conclusion, our results, emphasize the importance of physician’s and family’s awareness of the symptoms of diabetes in terms of early diagnosis and prevention of DKA during public health measures due to COVID-19.

show abstract

“…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.…”

Section: Diabetesmentioning

confidence: 99%

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

Calcaterra

Tagi

Santis

et al. 2023

JCM

View full text Add to dashboard Cite

Since the advent of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increased incidence of several endocrinological anomalies in acute-phase and/or long-term complications has been described. The aim of this review is to provide a broad overview of the available literature regarding changes in the worldwide epidemiology of endocrinological involvement in children since December 2019 and to report the evidence supporting its association with coronavirus disease 2019 (COVID-19). Although little is known regarding the involvement of endocrine organs during COVID-19 in children, the current evidence in adults and epidemiological studies on the pediatric population suggest the presence of a causal association between the virus and endocrinopathies. Untreated transient thyroid dysfunction, sick euthyroid syndrome, nonthyroidal illness syndrome, and hypothalamic–pituitary–adrenal (HPA) axis and central precocious puberty have been observed in children in acute infection and/or during multisystem inflammatory syndrome development. Furthermore, a higher frequency of ketoacidosis at onset in children with a new diagnosis of type 1 diabetes is reported in the literature. Although the direct association between COVID-19 and endocrinological involvement has not been confirmed yet, data on the development of different endocrinopathies in children, both during acute infection and as a result of its long-term complications, have been reported. This information is of primary importance to guide the management of patients with previous or current COVID-19.

show abstract

Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting With Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey

Cited by 9 publications

References 32 publications

Change in the Frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes in the Central Anatolia Region of Turkey over the Years Before and After the Coronavirus Disease 2019 Pandemic: A Single-Center Experience

Change in the Frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes in the Central Anatolia Region of Turkey over the Years Before and After the Coronavirus Disease 2019 Pandemic: A Single-Center Experience

Does the severity of diabetic ketoacidosis in children with type 1 diabetes change during the COVID-19 pandemic? A single-center experience from a Pediatric Intensive Care Unit

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

Contact Info

Product

Resources

About