The Impact of COVID‐19 Pandemic on Diabetic Children: A Systematic Review on the Current Evidence

Abstract

Coronavirus disease 2019 (COVID-19) pandemic is a worldwide public health emergency. Children seem less likely to be infected with COVID-19 and develop milder symptoms than adults if infected. However, there is limited data regarding the impact of COVID-19 pandemic on diabetic children. Objective: This systematic review aims to summarize and compile the available evidence of COVID-19 pandemic on the pediatric diabetic population, including the incidence of newly diagnosed patients, the risk of DKA and disturbed glycemic control, the use of telemedicine, the impact of lockdown on the daily dietary and physical activity routine, and the management of diabetes during the pandemic. Method: We conducted a comprehensive search of literature published in PubMed, Google Scholar, and Cochrane databases for studies published in English language within the last year as of October 1st, 2020 on the impact of COVID-19 pandemic on diabetic children. Results: We included 20 studies (7 incidence studies, 5 cross sectional, 2 observational, 4 case reports and 2 case series) with a total population of 1989 diabetic children and adolescents. The current evidence suggesting increased incidence of newly diagnosed type 1 diabetes (T1DM) during the COVID-19 pandemic is still weak. Several studies identified delayed diagnosis of children and adolescents with new-onset T1DM leading to presentation with severe DKA. Underlying causes contributed to this observation include reduced access to primary care services, limited availability of healthcare providers, and parental fear from infection during the pandemic period. Moreover, the current pandemic affected the availability of Insulin and glucose measuring supplies leading to poor glycemic control and increasing the risk of DKA among diabetic children especially in resource limited countries. Diabetic children and adolescents had shown good coping skills as a considerable number of them maintained their eating habits and regularly practiced physical activity at home during the lockdown period. In addition, the results of studies on the use of telemedicine for diabetic children and adolescents were positive regarding the effectiveness and patient satisfaction. Conclusion: More studies are required to document the association between COVID-19 infection and the development of T1DM, and to evaluate the physical and psychological impact of the current pandemic on diabetic children and adolescents. In preparation for any potential second wave, specific strategies are essential to alleviate the negative impact of the current pandemic on the management of diabetic children. In order to avoid delayed diagnosis of patients with new onset diabetes, countries should reopen the access to essential non-COVID-19 services, and families should be encouraged about timely attendance at the ED for children with symptoms that are not related to COVID-19. Telemedicine is a promising approach for the management of diabetic patients as it provides a safe, fast and effective way of communication between patients and their diabetic teams. Keywords: adolescents; children; COVID-19; diabetes mellitus and DKA; pediatrics; SARSCoV2