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The Effect Of COVID-19 on Children with Type 1 Diabetes

Apr 17, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: A'Kira Shavers,  PharmD Candidate, South College School of Pharmacy

Study found children with a new diagnosis of type 1 diabetes experienced higher rates of diabetic ketoacidosis in the COVID-19 pandemic.   

Germany-based children with a new diagnosis of type 1 diabetes are struggling more with their health than usual.  According to this study, during the coronavirus19 disease pandemic, patients experience higher diabetic ketoacidosis rates and more severe diabetic ketoacidosis than noticed in the previous two years, according to JAMA’s journal.  Diabetic ketoacidosis is an acute life-threatening complication of a delayed diagnosis of type 1 diabetes. Ketoacidosis also became a huge issue due to the coronavirus pandemic having lowered healthcare access.  The study investigated the frequency of diabetic ketoacidosis in children and adolescents with type 1 diabetes diagnosis in March to May 2020 during the coronavirus pandemic.   

 

This study was an analysis of data from the German Diabetes Prospective Follow-up Registry.  The study consisted of 532 children and adolescents with a median age of 9.9 years.  The children had to be newly diagnosed with type 1 diabetes from March 13, 2020, through May 13, 2020.  The study consisted of approximately 216 different diabetic centers in Germany.  The investigators assessed the overall diabetic ketoacidosis rate, defined by a pH level of less than 7.3 or a bicarbonate level of fewer than 15 millimoles per liter. Severe diabetic ketoacidosis is defined as a pH level of less than 7.1 or a bicarbonate level of fewer than five millimoles per liter.  The study used multivariable logistic regression analysis. The researchers gathered all the data about diabetic ketoacidosis and severe diabetic ketoacidosis during the coronavirus19 time period and compared it with the same time frame of years 2018 and 2019. Out of all children newly diagnosed with type 1 diabetes between March 13, 2020, and May 13, 2020, diabetic ketoacidosis was present in 44.7 percent (n=238); severe diabetic ketoacidosis was observed in 19.4 percent (n=103) of the children. The researchers noticed the frequency of diabetic ketoacidosis was higher during the coronavirus19 pandemic in comparison to the same period in 2019 (44.7% vs 24.5% in 2019 and 24.1% in 2018). The incidence of severe diabetic ketoacidosis was also significantly higher compared with the previous years (19.4% in 2020 vs 13.9% in 2019 & 12.3% in 2018). 

Children younger than 6 years had the highest risk for diabetic ketoacidosis (51.9% in 2020 vs 18.4% in 2019; 24.2% in 2018) and severe diabetic ketoacidosis (24.4% in 2020 vs 12.2%; 11.7% in 2018) during the pandemic. 

The study suggests the underlying cause may be multifactorial and reflect on the reduced medical service, fear of approaching the health care system, and more psychosocial factors. The study did have some limitations, such as the lack of data on the patient’s socioeconomic status and their family history of diabetes. The researchers suggested that additional study needs to be done to look into the potential factors that caused an increase in diabetic ketoacidosis during the coronavirus19 pandemic, and all the necessary steps to reduce diabetic ketoacidosis.  Some suggestions the researchers proposed were public and health care clinician education or Beta-cell antibody screening.   

Practice Pearls:  

  • It is imperative to encourage patients and their parents to still come for screenings and check-ups during a pandemic.   
  • Children should be screened for all disease states more frequently during pandemics and routinely.  
  • Diabetic ketoacidosis is significant to watch for in children less than six years of age.   

 

Brandon Miles May, Brandon May Follow. Diabetic Ketoacidosis Rates in Children With New T1D Diagnosis During COVID-19. Endocrinology Advisor, August 17, 2020  

Clemens Kamrath, MD. Ketoacidosis in Children and Adolescents With Type 1 Diabetes During the COVID-19 Pandemic in Germany. JAMA Network, August 25, 2020,         

 

AKira Shavers, PharmD Candidate 2021, South College School of Pharmacy