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.

Autor:	Birkebaek NH; Department of Pediatrics and Adolescent Medicine and Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark. Electronic address: nielbirk@rm.dk., Kamrath C; Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany., Grimsmann JM; Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany., Aakesson K; Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden., Cherubini V; Department of Women's and Children's Health, Salesi Hospital, Ancona, Italy., Dovc K; Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC Ljubljana, University Children's Hospital, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia., de Beaufort C; Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg., Alonso GT; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA., Gregory JW; Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, UK., White M; Department of Endocrinology and Diabetes, and Health Services Research Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Diabetes Research, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, VIC, Australia., Skrivarhaug T; Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Sumnik Z; Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czechia; University Hospital Motol, Prague, Czechia., Jefferies C; Starship Children's Health and University of Auckland, Auckland, New Zealand., Hörtenhuber T; Department of Pediatrics and Adolescent Medicine, Kepler University Clinic, Linz, Austria., Haynes A; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia., De Bock M; Department of Paediatrics, University of Otago, Christchurch, New Zealand., Svensson J; Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Warner JT; Department of Paediatric Endocrinology and Diabetes, Children's Hospital for Wales, Cardiff, UK., Gani O; Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Gesuita R; Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy., Schiaffini R; Diabetes Unit, Bambino Gesù Childrens' Hospital, Rome, Italy., Hanas R; NU Hospital Group, Uddevalla, Trollhättan, Sweden; Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden., Rewers A; Denver Scool of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA., Eckert AJ; Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany., Holl RW; Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany., Cinek O; Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czechia; University Hospital Motol, Prague, Czechia.
Jazyk:	angličtina
Zdroj:	The lancet. Diabetes & endocrinology [Lancet Diabetes Endocrinol] 2022 Nov; Vol. 10 (11), pp. 786-794. Date of Electronic Publication: 2022 Oct 03.
DOI:	10.1016/S2213-8587(22)00246-7
Abstrakt:	Background: An increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in children was observed in various diabetes centres worldwide during the COVID-19 pandemic. We aimed to evaluate trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes before and during the COVID-19 pandemic, and to identify potential predictors of changes in diabetic ketoacidosis prevalence during the pandemic. Methods: For this international multicentre study, we used data from 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA [Colorado], and Wales). The study population comprised 104 290 children and adolescents aged 6 months to younger than 18 years, who were diagnosed with type 1 diabetes between Jan 1, 2006, and Dec 31, 2021. The observed diabetic ketoacidosis prevalence in 2020 and 2021 was compared to predictions based on trends over the pre-pandemic years 2006-19. Associations between changes in diabetic ketoacidosis prevalence and the severity of the COVID-19 pandemic and containment measures were examined with excess all-cause mortality in the whole population and the Stringency Index from the Oxford COVID-19 Government Response Tracker. Findings: 87 228 children and adolescents were diagnosed with type 1 diabetes between 2006 and 2019, 8209 were diagnosed in 2020, and 8853 were diagnosed in 2021. From 2006 to 2019, diabetic ketoacidosis at diagnosis of type 1 diabetes was present in 23 775 (27·3%) of 87 228 individuals and the mean annual increase in the prevalence of diabetic ketoacidosis in the total cohort from 2006 to 2019 was 1·6% (95% CI 1·3 to 1·9). The adjusted observed prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes was 39·4% (95% CI 34·0 to 45·6) in 2020 and 38·9% (33·6 to 45·0) in 2021, significantly higher than the predicted prevalence of 32·5% (27·8 to 37·9) for 2020 and 33·0% (28·3 to 38·5) for 2021 (p<0·0001 for both years). The prevalence of diabetic ketoacidosis was associated with the pandemic containment measures, with an estimated risk ratio of 1·037 (95% CI 1·024 to 1·051; p<0·0001) per ten-unit increase in the Stringency Index for 2020 and 1·028 (1·009 to 1·047; p=0·0033) for 2021, but was not significantly associated with excess all-cause mortality. Interpretation: During the COVID-19 pandemic, there was a marked exacerbation of the pre-existing increase in diabetic ketoacidosis prevalence at diagnosis of type 1 diabetes in children. This finding highlights the need for early and timely diagnosis of type 1 diabetes in children and adolescents. Funding: German Federal Ministry for Education and Research, German Robert Koch Institute, German Diabetes Association, German Diabetes Foundation, Slovenian Research Agency, Welsh Government, Central Denmark Region, and Swedish Association of Local Authorities and Regions. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2022 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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