The Impact of COVID‐19 Pandemic on Prevalence of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: A Single‐Centre Study in Central Pennsylvania

Abstract

The majority of patients with Type 1 Diabetes Mellitus (T1D) present with similar symptoms including polyuria, polydipsia, weight loss and fatigue. Unfortunately, some patients progress to diabetic ketoacidosis (DKA) at the time of diagnosis of T1D 1 . Children diagnosed in DKA have increased risk of morbidity, mortality, poor glycaemic control, higher medical costs and healthcare resource utilization including ICU level care 1,2 . Previous research has identified the predictors for children to present in DKA, which include younger children (under 5 years of age), Hispanic or African American race, low socioeconomic status, misdiagnosis at an initial clinical encounter and lack of private health insurance 3 . Thus far, there are limited data on the impact of the COVID-19 pandemic on the rate and severity of DKA in children at initial diagnosis of T1D. Interestingly, some geographic locations noted an increase in DKA frequency during the

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.…”

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

“…After the title and abstract screening and removing the duplicates, 113 articles were eliminated, and 38 full-text articles were evaluated for eligibility. Following the full-text screening, 24 papers 11 – 14 , 19 , 20 , 23 – 41 met our criteria. Finally, 17 studies were included in our meta-analysis, and 7 were included only in our systematic review as they did not provide sufficient data to be included in the meta-analysis, so we included them as qualitative analysis (Fig.…”

“…Proving an increase in DKA during the COVID-19 pandemic will not only shed light on such life-threatening complications but also be a step to overcome the fear of approaching healthcare settings, increase awareness about such complications during the upcoming waves, and our increased dependence on telemedicine. 15 – 18 Thus, our meta-analysis and systematic review aimed to further investigate the relationship between COVID-19 and pediatric DKA to fill the knowledge gap, settle the controversy between different studies, 10 – 14 , 19 , 20 and answer the question of whether DKA has increased in the COVID-19 pandemic.…”

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.…”