Has the COVID-19 Pandemic Affected the Prevalence of Diabetic Ketoacidosis in Polish Children with Newly Diagnosed Type 1 Diabetes? An Example of the Largest Polish Pediatric Diabetes Center (Upper Silesia-Katowice, Poland).

Ewa Rusak,Przemysław Dyś,Natalia Furgał,Przemysława Jarosz-Chobot,Sebastian Seget,Maksymilian Macherski

doi:10.3390/healthcare10020348

Abstract

Purpose: The aim of this study was to analyze the prevalence of diabetic ketoacidosis (DKA) in children with newly disclosed type 1 diabetes (T1D) during the COVID-19 pandemic in 2020 compared to 2019. Methods: A retrospective analysis of the history database of all hospitalized children in our department. The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines were used for the diagnosis of DKA. Results: The database of children with newly disclosed T1D included 196 patients (89 girls and 107 boys) from 2019, and 223 patients (113 girls and 110 boys) from 2020 (a total of 419 patients—202 girls and 217 boys) aged 0 to 18 years. A significantly higher percentage of DKA was observed in 2020 compared to the previous year (47.53% vs. 35.2% [p = 0.005]). The percentage of severe DKA increased in 2020 compared to 2019 (18.39% vs. 14.07% [p = 0.118]). Compared to 2019, the average HbA1c level was higher in 2020 (12.57 ± 2.75% vs. 11.95 ± 2.89% [p < 0.025]), and the average pH level (7.26 vs. 7.31 [p = 0.002], and average HCO3 level (16.40 vs. 18.66 [p = 0.001]) were lower, respectively. Conclusions: During the COVID-19 (2020) pandemic, the incidence of DKA increased in Polish children with newly diagnosed T1D. The conclusions from the analysis of the functioning of health systems during the pandemic should be used in the future to prevent, in similar periods, an increase in severe complications of delayed diagnosis of T1D.

Highlights

One of the coronaviruses—SARS-CoV-2 spread rapidly around the world, causing a worldwide pandemic of COVID-19, which was confirmed by the World Health Organization (WHO) on 11 March 2020
Among children with newly diagnosed Type 1 Diabetes (T1D), a significantly higher percentage of diabetic ketoacidosis (DKA) was observed in 2020 compared to the previous year (47.53% vs. 35.2% [p = 0.005])
Our results reveal the fact that even a very well-developed network of health care units during the COVID-19 pandemic did not prevent a significant deterioration of diagnostic diabetes care

Summary

Introduction

One of the coronaviruses—SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) spread rapidly around the world, causing a worldwide pandemic of COVID-19 (coronavirus disease 2019), which was confirmed by the World Health Organization (WHO) on 11 March 2020. Children and adolescents, having a milder, often asymptomatic course of COVID-19, have a lower risk of hospitalization than adults [1,2,3]. It has been reported that in some children, the course of COVID-19 may be severe, including cases of multi-organ failure [3,4,5]. According to the estimates of the International Diabetes Federation (IDF), over 1.1 million children and adolescents worldwide have Type 1 Diabetes (T1D) [6]. Some studies indicate that both children and adolescents with diabetes are not more susceptible to SARS-CoV-2 infection than their non-diabetic peers [7,8,9]. To reduce the number of cases, many countries, including Poland, implemented numerous restrictions, aimed at limiting SARS-CoV-2 transmission by restraining interpersonal contacts. Many guardians delayed seeking emergency help for their children, due to the reduction of service for non-COVID-19 patients [8]

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