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Wersäll JH, Ekelund J, Åkesson K, Hanas R, Adolfsson P, Ricksten SE, Forsander G. Relative poverty is associated with increased risk of diabetic ketoacidosis at onset of type 1 diabetes in children. A Swedish national population-based study in 2014-2019. Diabet Med 2024; 41:e15283. [PMID: 38213059 DOI: 10.1111/dme.15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/13/2024]
Abstract
AIMS The aim of the study was to estimate the effect of household relative poverty on the risk of diabetic ketoacidosis at diagnosis of children with type 1 diabetes using an international standard measurement of relative poverty. METHODS A national population-based retrospective study was conducted. The Swedish National Diabetes Register (NDR) was linked with data from Sweden's public statistical agency (Statistics Sweden). Children who were diagnosed with new-onset type 1 diabetes in the period of 2014-2019 were common identifiers. The definition of diabetic ketoacidosis was venous pH <7.30 or a serum bicarbonate level <18 mmol/L. The exposure variable was defined according to the standard definition of the persistent at-risk-of-poverty rate used by the statistical office of the European Union (Eurostat) and several other European public statistical agencies. Univariate and multi-variable analyses were used to calculate the effect of relative poverty on the risk of diabetic ketoacidosis. RESULTS Children from households with relative poverty had a 41% higher risk of diabetic ketoacidosis (1.41, CI 1.12-1.77, p = 0.004) and more than double the risk of severe diabetic ketoacidosis (pH <7.10) (RR 2.10, CI 1.35-3.25, p = 0.001), as compared to children from households without relative poverty. CONCLUSIONS Relative poverty significantly increases the risk of diabetic ketoacidosis at onset of type 1 diabetes in children, even in a high-income country with publicly reimbursed health care.
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Affiliation(s)
- Johan H Wersäll
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Karin Åkesson
- Division of Paediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ragnar Hanas
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Adolfsson
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gun Forsander
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hirschler V, Gonzalez CD, Krochik G, Rousos AM, Andres ME, Riera F, Ibarcena PP, Molinari C, Porta LFP, Prieto M, Mateu CM, Barcala C, Arrigo MA, Tachetti J, Raggio M, Vacarezza V, Major ML, Sobrero AF, Bogado E, Lopez S, Povedano PP, Scaiola E, Leiva F, Pacheco G, Pasayo P, Dupuy M, Torossi MB, Benitez AJ, Marassi AE, Caballero Z, Garcia AL, Mazzetti S, Pugliese MIR, Gonzalez DS, Grabois F, Villar CMDA, Flores AB. Diabetic Ketoacidosis in Type 1 Diabetes Onset in Latin American Children. J Pediatr Health Care 2024; 38:544-551. [PMID: 38597850 DOI: 10.1016/j.pedhc.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/19/2023] [Accepted: 01/28/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022. METHODS A retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM. RESULTS A total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60-0.86)], BMI [OR, 0.95 (95% CI 0.92-0.99)], and medical insurance [OR, 0.75 (95% CI 0.60-0.94)] adjusted for sex. CONCLUSION Latin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.
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Affiliation(s)
- Valeria Hirschler
- Coordinator of the Diabetes Argentine Society, Epidemiology, CAPITAL FEDERAL, Argentina.
| | - Claudio D Gonzalez
- Coordinator of the Diabetes Argentine Society, Epidemiology, CAPITAL FEDERAL, Argentina
| | - Gabriela Krochik
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Adriana M Rousos
- Head Physician Hospital de Niños Ricardo Gutierrez, Nutrition, Buenos Aires, Argentina
| | - Maria E Andres
- Head Physician Hospital de Niños Pedro de Elizalde, Nutrition, Buenos Aires, Argentina
| | - Francisca Riera
- Head Physician Pontificia Universidad Católica de Chile, Santiago, Chile, Pediatric Endocrinology, Santiago de Chile, Chile
| | - Paola Pinto Ibarcena
- Head Physician Endocrinology and Metabolism Service of the National Institute of Child Health, Lima, Peru
| | - Claudia Molinari
- Professor of the University of Buenos Aires, School of Pharmacy and Biochemistry, Mathematics, Buenos Aires, Argentina
| | | | - Mariana Prieto
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Consuelo Barcala
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Maria A Arrigo
- Head Physician HOSPITAL RAMON EXENI, San Justo, Argentina
| | - Jacqueline Tachetti
- Head Physician Hospital Italiano de San Justo Agustín Rocca, San JustoO, Argentina
| | - Marcela Raggio
- Head Physician Hospital Universitario Austral, Pilar, Argentina
| | | | - Maria L Major
- Head Physician Hospital Materno Infantil de San Isidro, San Isidro, Argentina
| | | | | | - Stella Lopez
- Head Physician Hospital Infantil Municipal, Cordoba, Argentina
| | - Paula Paz Povedano
- Head Physician Hospital de Niños de la Santísima Trinidad de Cordoba, Cordoba, Argentina
| | - Edit Scaiola
- Head Physician Private Clinic former Ushuaia, Ushuaia, Argentina
| | - Fabiana Leiva
- Head Physician Hospital Regional Rio Grande, Rio Grande, Argentina
| | - Gabriela Pacheco
- Head Physician Hospital Publico Materno Infantil De Salta, Pediatric Endocrinology, Salta, Argentina
| | - Patricia Pasayo
- Head Physician Hospital Materno Infantil Dr Hector Quintana, San Salvador De Jujuy, Argentina
| | - Mariana Dupuy
- Head Physician Hospital del niño Jesús - Tucumán, San Miguel De Tucuman, Argentina
| | - Maria B Torossi
- Head Physician Hospital de Clínicas Pte. Dr. Nicolás Avellaneda, San Miguel de Tucuman, Argentina
| | - Amanda J Benitez
- Amanda J. Benitez-Hospital Pediatrico Juan Pablo Segundo, Corrientes, Argentina
| | | | - Zulema Caballero
- Head Physician Hospital Pediatrico Dr. Avelino Lorenzo Castelán, Resistencia, Argentina
| | - Ana L Garcia
- Head Physician Hospital de Niños Orlando Alassia, Santa Fe, Argentina
| | - Sandra Mazzetti
- Head Physician Hospital de Niños Victor J Vilela, Rosario, Argentina
| | | | - Diana S Gonzalez
- Hospital Provincial Neuquen Dr. Castro Rendon, Neuquen, Argentina
| | | | | | - Adriana B Flores
- Head Physician Fundacion Hospitalaria Htal privado materno infanto juvenil, Buenos Aires, Argentina
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Scudder C, Townson J, Bowen-Morris J, Gillespie K, Evans P, Jones S, Thomas NPB, Stanford J, Fox R, Todd JA, Greenfield S, Dayan CM, Besser REJ. General population screening for type 1 diabetes using islet autoantibodies at the preschool vaccination visit: a proof-of-concept study (the T1Early study). Arch Dis Child 2024:archdischild-2023-326697. [PMID: 38925883 DOI: 10.1136/archdischild-2023-326697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Type 1 diabetes (T1D) screening programmes testing islet autoantibodies (IAbs) in childhood can reduce life-threatening diabetic ketoacidosis. General population screening is required to detect the majority of children with T1D, since in >85% there is no family history. Age 3-5 years has been proposed as an optimal age for a single screen approach. DESIGN Capillary samples were collected from children attending their preschool vaccination and analysed for IAbs to insulin, glutamic acid decarboxylase, islet antigen-2 and zinc transporter 8 using radiobinding/luciferase immunoprecipitation system assays. Acceptability was assessed using semistructured interviews and open-ended postcard questionnaires with parents. SETTING Two primary care practices in Oxfordshire, UK. MAIN OUTCOME MEASURES The ability to collect capillary blood to test IAbs in children at the routine preschool vaccination (3.5-4 years). RESULTS Of 134 parents invited, 66 (49%) were recruited (median age 3.5 years (IQR 3.4-3.6), 26 (39.4%) male); 63 provided a sample (97% successfully), and one participant was identified with a single positive IAb. Parents (n=15 interviews, n=29 postcards) were uniformly positive about screening aligned to vaccination and stated they would have been less likely to take part had screening been a separate visit. Themes identified included preparedness for T1D and the long-term benefit outweighing short-term upset. The perceived volume of the capillary sample was a potential concern and needs optimising. CONCLUSIONS Capillary IAb testing is a possible method to screen children for T1D. Aligning collection to the preschool vaccination visit can be convenient for families without the need for an additional visit.
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Affiliation(s)
- Claire Scudder
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Julia Townson
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Jane Bowen-Morris
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - Kathleen Gillespie
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Philip Evans
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | | | | | | | - Robin Fox
- Bicester Health Centre, Bicester, UK
| | - John A Todd
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Colin M Dayan
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Rachel E J Besser
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
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Shebani MS, Khashebi RM. Exploring ketoacidosis frequency and risk factors in childhood-onset type 1 diabetes: an 8-year retrospective study (2011-2018) at a tertiary paediatric hospital in Tripoli, Libya. J Pediatr Endocrinol Metab 2024; 37:497-504. [PMID: 38695494 DOI: 10.1515/jpem-2024-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/29/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES Diabetic ketoacidosis (DKA) stands as a critical, acute complication of type 1 diabetes. Despite its severity, there exists a dearth of data concerning the frequency and prevalence of DKA at the onset of type 1 diabetes in Libyan children. This study aimed to ascertain the frequency of DKA during the initial presentation of type 1 diabetes among children aged 0.5-14 years admitted to Tripoli Children's Hospital between 2011 and 2018. METHODS Employing a retrospective approach, the study examined the proportion of children with newly diagnosed type 1 diabetes who presented with DKA. Data analysis included estimating DKA frequency concerning age at presentation, sex, and age groups. The comparative analysis involved assessing DKA frequency between 0.5 and <2 and 2-14 years age groups. Logistic regression analysis evaluated the impact of age group, sex, and family history of type 1 diabetes on DKA and severe DKA occurrence. RESULTS Among 497 children with newly diagnosed type 1 diabetes, 39.2 % presented with DKA, of these 44.5 % had severe DKA. Females exhibited a higher DKA rate than males (OR 1.63, 95 % CI 1.13-2.34, p=0.009). Very young children (0.5 to <2 years) presented with DKA more frequently than those aged 2-14 years (OR 4.73, 95 % CI 2.65-8.47, p<0.001), and they were more likely to present in severe DKA (63.9 vs. 39.1 %, [OR 7.26, 95 % CI 3.65-14.41, p<0.001]). CONCLUSIONS The frequency of DKA at type 1 diabetes onset among children admitted to Tripoli Children's Hospital is notably high, with nearly half of the DKA episodes categorized as severe. Very young children notably demonstrated a fivefold increase in the likelihood of presenting with DKA.
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Affiliation(s)
- Mostafa Sasi Shebani
- Paediatric Endocrinology and Diabetes Department, 612518 Tripoli Children's Hospital , Tripoli, Libya
- Paediatric Department, Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Rowida Mohammed Khashebi
- Paediatric Endocrinology and Diabetes Department, 612518 Tripoli Children's Hospital , Tripoli, Libya
- Paediatric Department, Faculty of Medicine, University of Tripoli, Tripoli, Libya
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Aanstoot HJ, Varkevisser RDM, Mul D, Dekker P, Birnie E, Boesten LSM, Brugts MP, van Dijk PR, Duijvestijn PHLM, Dutta S, Fransman C, Gonera RK, Hoogenberg K, Kooy A, Latres E, Loves S, Nefs G, Sas T, Vollenbrock CE, Vosjan-Noeverman MJ, de Vries-Velraeds MMC, Veeze HJ, Wolffenbuttel BHR, van der Klauw MM. Cohort profile: the 'Biomarkers of heterogeneity in type 1 diabetes' study-a national prospective cohort study of clinical and metabolic phenotyping of individuals with long-standing type 1 diabetes in the Netherlands. BMJ Open 2024; 14:e082453. [PMID: 38904129 PMCID: PMC11191834 DOI: 10.1136/bmjopen-2023-082453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/30/2024] [Indexed: 06/22/2024] Open
Abstract
PURPOSE The 'Biomarkers of heterogeneity in type 1 diabetes' study cohort was set up to identify genetic, physiological and psychosocial factors explaining the observed heterogeneity in disease progression and the development of complications in people with long-standing type 1 diabetes (T1D). PARTICIPANTS Data and samples were collected in two subsets. A prospective cohort of 611 participants aged ≥16 years with ≥5 years T1D duration from four Dutch Diabetes clinics between 2016 and 2021 (median age 32 years; median diabetes duration 12 years; 59% female; mean glycated haemoglobin (HbA1c) 61 mmol/mol (7.7%); 61% on insulin pump; 23% on continuous glucose monitoring (CGM)). Physical assessments were performed, blood and urine samples were collected, and participants completed questionnaires. A subgroup of participants underwent mixed-meal tolerance tests (MMTTs) at baseline (n=169) and at 1-year follow-up (n=104). Genetic data and linkage to medical and administrative records were also available. A second cross-sectional cohort included participants with ≥35 years of T1D duration (currently n=160; median age 64 years; median diabetes duration 45 years; 45% female; mean HbA1c 58 mmol/mol (7.4%); 51% on insulin pump; 83% on CGM), recruited from five centres and measurements, samples and 5-year retrospective data were collected. FINDINGS TO DATE Stimulated residual C-peptide was detectable in an additional 10% of individuals compared with fasting residual C-peptide secretion. MMTT measurements at 90 min and 120 min showed good concordance with the MMTT total area under the curve. An overall decrease of C-peptide at 1-year follow-up was observed. Fasting residual C-peptide secretion is associated with a decreased risk of impaired awareness of hypoglycaemia. FUTURE PLANS Research groups are invited to consider the use of these data and the sample collection. Future work will include additional hormones, beta-cell-directed autoimmunity, specific immune markers, microRNAs, metabolomics and gene expression data, combined with glucometrics, anthropometric and clinical data, and additional markers of residual beta-cell function. TRIAL REGISTRATION NUMBER NCT04977635.
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Affiliation(s)
- Henk-Jan Aanstoot
- Diabeter Netherlands, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
| | | | - Dick Mul
- Diabeter Netherlands, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
| | - Pim Dekker
- Diabeter Netherlands, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
| | - Erwin Birnie
- Diabeter Netherlands, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
- Department of Genetics, UMCG, Groningen, Groningen, The Netherlands
| | - Lianne S M Boesten
- Department of Clinical Chemistry, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - Michael P Brugts
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | | | | | | | - Christine Fransman
- Diabeter Netherlands, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
| | - Rob K Gonera
- Department of Internal Medicine, Wilhelmina Hospital, Assen, The Netherlands
| | - Klaas Hoogenberg
- Department of Internal Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Adriaan Kooy
- Bethesda Diabetes Research Center & Treant, Treant Care Group, Hoogeveen, Drenthe, The Netherlands
- Department of Internal Medicine, UMCG, Groningen, Groningen, Netherlands
| | | | - Sandra Loves
- Department of Internal Medicine, Treant Care Group, Hoogeveen, Drenthe, Netherlands
| | - Giesje Nefs
- Diabeter Netherlands, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological disordersand Somatic diseases (CoRPS), Tilburg, Netherlands
| | - Theo Sas
- Diabeter Netherlands, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
- Department of Paediatrics, Division of Paediatric Endocrinology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | - Henk J Veeze
- Diabeter Netherlands, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
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İzci Güllü E, Akin L, Gökler ME, Aydin M. Increased Severity of Presentation Signs in Children with Newly Diagnosed Type 1 Diabetes during the COVID-19 Pandemic: A Tertiary Center Experience. ANNALS OF NUTRITION & METABOLISM 2024; 80:161-170. [PMID: 38479369 DOI: 10.1159/000538322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/11/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) is an important complication of type 1 diabetes mellitus (T1DM) which is worsened when the diagnosis of T1DM is delayed. The aim of this study was to evaluate the presentation patterns, severity, autoantibody status, and seasonal variability of newly diagnosed T1DM patients during the pandemic period of 2 years compared to those in the pre-pandemic period. METHODS In this single tertiary center retrospective cohort study, newly diagnosed T1DM patients were grouped as pre-pandemic and pandemic period. Age, gender, the month of diagnosis, hemoglobin A1c, venous blood gas parameters, duration of symptoms, glutamic-acid-decarboxylase-antibody (anti-GAD), islet-cell antibody (ICA), and insulin autoantibody levels were recorded. The data obtained were compared between the groups. RESULTS Number of patients presenting with DKA was significantly higher during the pandemic period (92 [65.7%] vs. 62 [40.8%] patients, p < 0.001). In terms of clinical severity of DKA, pH, and HCO3 levels were lower during the pandemic period (p < 0.001), while the number of patients presenting with severe DKA was significantly higher during the pandemic period (41 [44.6%] vs. 17 [27.4%] patients, p = 0.031). ICA positivity was significantly higher in patients admitted during the pandemic period (47 [36.4%] vs. 21 patients [16.9%], p < 0.001), especially in the second year of the pandemic (p < 0.001). Anti-GAD-ICA co-positivity was significantly higher in patients admitted during the pandemic period and also in second year of the pandemic (p < 0.001). CONCLUSION DKA rates increased in newly diagnosed T1DM cases during the pandemic. Despite the relaxation of bans, the second year of the pandemic also saw increased rates of DKA and severe DKA compared to the pre-pandemic period. The significantly increased ICA positivity in the pandemic may support the effects of COVID-19 on autoimmune T1DM.
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Affiliation(s)
- Elif İzci Güllü
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
- University of Health Sciences, Samsun Training and Research Hospital, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Leyla Akin
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Mehmet Enes Gökler
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Department of Public Health, Ankara, Turkey
| | - Murat Aydin
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
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7
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Pérez Unanua MP, López Simarro F, Novillo López CI, Olivares Loro AG, Yáñez Freire S. [Diabetes and women, why are we different?]. Semergen 2024; 50:102138. [PMID: 38052103 DOI: 10.1016/j.semerg.2023.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/30/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023]
Abstract
Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes.
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Affiliation(s)
- M P Pérez Unanua
- Medicina de Familia, Centro de Salud Dr. Castroviejo, Madrid, España.
| | | | | | - A G Olivares Loro
- Medicina de Familia, Centro de Salud Esperanza Macarena, Sevilla, España
| | - S Yáñez Freire
- Medicina de Familia, Centro de Salud A Estrada, Santiago de Compostela, A Coruña, España
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Kao KT, Lei S, Cheek JA, White M, Hiscock H. Paediatric diabetes-related presentations to emergency departments in Victoria, Australia from 2008 to 2018. Emerg Med Australas 2024; 36:101-109. [PMID: 37783473 DOI: 10.1111/1742-6723.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/28/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES Despite significant treatment advances in paediatric diabetes management, ED presentations for potentially preventable (PP) complications such as diabetic ketoacidosis (DKA) remains a major issue. We aimed to examine the characteristics, rates and trends of diabetes-related ED presentations and subsequent admissions in youth aged 0-19 years from 2008 to 2018. METHODS Data were obtained from the Victorian Emergency Minimum Dataset and the National Diabetes Register. A diabetes-related ED presentation is defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes. 'Non-preventable' presentations were the number of youths with newly diagnosed diabetes, and the remaining are classified as PP diabetes-related presentations. Poisson regression model was used to examine the trends in incidence rate and prevalence. RESULTS Four thousand eight hundred and seventy-two (59%) of 8220 presentations were PP, 4683 (57%) were for DKA whereas 6200 (82%) required hospital admission. Diabetes-related ED presentations decreased from 38.4 to 27.5 per 100 youth with diabetes per year between 2008 and 2018 (β = -0.04; confidence interval [CI] -0.04 to -0.03; P < 0.001). Females, those aged 0-4 years and rural youth had higher rates of ED presentations than males, older age groups and metropolitan youth. DKA presentations decreased from 20.1 presentations per 100 youth with diabetes in 2008-2009 to 14.9 presentations per 100 youth with diabetes in 2017-2018. The rate of DKA presentations was 68% higher in rural areas compared to metropolitan areas (incidence rate ratio 1.68; CI 1.59-1.78; P < 0.001). CONCLUSIONS Although the rates of diabetes-related ED presentations declined, PP diabetes-related presentations and subsequent hospitalisation remain high. Patient level research is required to understand the increased DKA presentations in rural youth.
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Affiliation(s)
- Kung-Ting Kao
- Department of Endocrinology and Diabetes, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shaoke Lei
- Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - John A Cheek
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mary White
- Department of Endocrinology and Diabetes, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
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王 晓, 龚 爱, 齐 晟, 刘 兰. [Risk factors for ketoacidosis in children/adolescents with type 1 diabetes mellitus and establishment of a predictive model]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:62-66. [PMID: 38269461 PMCID: PMC10817738 DOI: 10.7499/j.issn.1008-8830.2308042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/31/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To investigate the risk factors for diabetic ketoacidosis (DKA) in children/adolescents with type 1 diabetes mellitus (T1DM) and to establish a model for predicting the risk of DKA. METHODS A retrospective analysis was performed on 217 children/adolescents with T1DM who were admitted to General Hospital of Ningxia Medical University from January 2018 to December 2021. Among the 217 children/adolescents,169 cases with DKA were included as the DKA group and 48 cases without DKA were included as the non-DKA group. The risk factors for DKA in the children/adolescents with T1DM were analyzed, and a nomogram model was established for predicting the risk of DKA in children/adolescents with T1DM. RESULTS For the 217 children/adolescents with T1DM, the incidence rate of DKA was 77.9% (169/217). The multivariate logistic regression analysis showed that high levels of random blood glucose, hemoglobin A1c (HbA1c), blood ketone body, and triglyceride on admission were closely associated with the development of DKA in the children/adolescents with T1DM (OR=1.156, 3.2031015, 20.131, and 9.519 respectively; P<0.05). The nomogram prediction model had a C-statistic of 0.95, with a mean absolute error of 0.004 between the risk of DKA predicted by the nomogram model and the actual risk of DKA, indicating that the model had a good overall prediction ability. CONCLUSIONS High levels of random blood glucose, HbA1c, blood ketone body, and triglyceride on admission are closely associated with the development of DKA in children/adolescents with T1DM, and targeted intervention measures should be developed to reduce the risk of DKA.
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10
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Leete P. Type 1 diabetes in the pancreas: A histological perspective. Diabet Med 2023; 40:e15228. [PMID: 37735524 DOI: 10.1111/dme.15228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
AIMS This review aims to introduce research in the pancreas to a broader audience. The pancreas is a heterocrine gland residing deep within our abdominal cavity. It is the home to our islets, which play a pivotal role in regulating metabolic homeostasis. Due to its structure and location, it is an impossible organ to study, in molecular detail, in living humans, and yet, understanding the pancreas is critical if we aim to characterise the immunopathology of type 1 diabetes (T1D) and one day prevent the triggering of the autoimmune attack associated with ß-cell demise. METHODS Over a 100 years ago, we began studying pancreatic histology using cadaveric samples and clever adaptations to microscopes. As histologists, some may say nothing much has changed. Nevertheless, our microscopes can now interrogate multiple proteins at molecular resolution. Images of pancreas sections are no longer constrained to a single field of view and can capture a thousands and thousands of cells. AI-image-analysis packages can analyse these massive data sets offering breakthrough findings. CONCLUSION This narrative review will provide an overview of pancreatic anatomy, and the importance of research focused on the pancreas in T1D. It will range from histological breakthroughs to briefly discussing the challenges associated with characterising the organ. I shall briefly introduce a selection of the available global biobanks and touch on the distinct pancreatic endotypes that differ immunologically and in ß-cell behaviour. Finally, I will introduce the idea of developing a collaborative tool aimed at developing a cohesive framework for characterising heterogeneity and stratifying endotypes in T1D more readily.
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Affiliation(s)
- Pia Leete
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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11
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Kashfi K, Anbardar N, Asadipooya A, Asadipooya K. Type 1 Diabetes and COVID-19: A Literature Review and Possible Management. Int J Endocrinol Metab 2023; 21:e139768. [PMID: 38666042 PMCID: PMC11041820 DOI: 10.5812/ijem-139768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 04/28/2024] Open
Abstract
Context Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection normally damages the respiratory system but might likewise impair endocrine organs' function. Thyroid dysfunction and hyperglycemia are common endocrine complications of SARS-CoV-2 infection. The onset of type 1 diabetes (T1D) and associated complications, including diabetic ketoacidosis (DKA), hospitalization, and death, are thought to have increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to review the available data about the incidence rate of T1D and accompanying complications since the beginning of the COVID-19 pandemic. Evidence Acquisition A literature review was conducted using the electronic databases PubMed and Google Scholar. The keywords "T1D, T1DM, Type 1 DM or Type 1 Diabetes", "Coronavirus, SARS-CoV-2 or COVID-19" were used to search these databases. Titles and abstracts were screened for selection, and then relevant studies were reviewed in full text. Results A total of 25 manuscripts out of 304 identified studies were selected. There were 15 (60%) multicenter or nationwide studies. The data about the incidence rate of T1D, hospitalization, and death are not consistent across countries; however, DKA incidence and severity seem to be higher during the COVID-19 pandemic. The present study's data collection demonstrated that COVID-19 might or might not increase the incidence of T1D. Nevertheless, it is associated with the higher incidence and severity of DKA in T1D patients. This finding might indicate that antivirals are not fully protective against the endocrine complications of SARS-CoV-2 infection, which promotes the application of an alternative approach. Conclusions Combining medications that reduce SARS-CoV-2 entry into the cells and modulate the immune response to infection is an alternative practical approach to treating COVID-19.
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Affiliation(s)
- Kebria Kashfi
- Department of Clinical Medicine, Florida International University AUACOM, Florida, USA
| | - Narges Anbardar
- Department of Clinical Medicine, SMUSOM, Cleveland Clinic Lerner College of Medicine, Ohio, USA
| | - Artin Asadipooya
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Kamyar Asadipooya
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, Kentucky, USA
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12
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Chepulis L, Papa V, Lao C, Wu J, Riguetto CM, McClintock JM, Paul RG. Epidemiology of Diabetic Ketoacidosis in the Waikato Region of New Zealand: 2000-2019. J Diabetes Res 2023; 2023:4715783. [PMID: 37720598 PMCID: PMC10505083 DOI: 10.1155/2023/4715783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 09/19/2023] Open
Abstract
Aims Diabetic ketoacidosis (DKA) is not well characterised in New Zealand. This study is aimed at characterising the change in epidemiology and severity of DKA from 2000 to 2019 at a tertiary hospital in the Waikato region of New Zealand. Methods A retrospective clinical data review of all patients admitted to Waikato District Health Board hospitals with DKA was undertaken. Characteristics and severity of DKA were assessed by type of DKA admission (diagnosed at admission, nonrecurrent, and recurrent), ethnicity, social deprivation, intensive care unit (ICU) admission, and length of hospital stay, with linear regression reporting on changes over time. Results There were 1254 admissions for DKA (564 individual patients), two-thirds being recurrent events. Nonrecurrent DKA patients were younger, whilst recurrent admissions for DKA were associated with T1D, female gender, greater socioeconomic deprivation, and rural living (all P values < 0.01). DKA admission increased 8-fold between 2000 and 2019, mostly due to an increased number of recurrent events, particularly in Māori and female patients (P < 0.001). ICU admissions increased over time (P < 0.001) whilst length of hospital stay trended down (P = 0.031). Conclusions The rise in recurrent DKA is concerning, particularly in youth and indigenous Māori. Healthcare inequities need to be addressed, including adequate access to mental health support to ensure optimal outcomes for all patients with diabetes.
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Affiliation(s)
- Lynne Chepulis
- Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Valentina Papa
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Justina Wu
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | | | - Joanna M. McClintock
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - Ryan G. Paul
- Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand, Hamilton, New Zealand
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13
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Agarwal A, Bansal D, Nallasamy K, Jayashree M, William V. Pediatric Diabetes and Diabetic Ketoacidosis After COVID-19: Challenges Faced and Lessons Learnt. Pediatric Health Med Ther 2023; 14:281-288. [PMID: 37691882 PMCID: PMC10488656 DOI: 10.2147/phmt.s384104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic affected the management and follow-up of several chronic ailments, including pediatric type 1 diabetes mellitus (T1DM). Restricted access to healthcare and fear of contracting the virus during medical facility visits resulted in poor compliance, irregular follow-up visits, treatment, and delayed diagnosis of complications in pediatric diabetes such as diabetic ketoacidosis (DKA). As such, the incidence of complicated DKA in resource-limited settings is high due to delayed presentation, poor compliance with therapy, and associated comorbidities such as malnutrition and sepsis. The pandemic had only added to the woes. The increased surge in DKA, in the face of limited resources, prompted clinicians to find alternative solutions to manage these children effectively. In this narrative review, we discuss the key challenges faced globally while caring for children with T1DM and DKA during the COVID-19 pandemic, and the lessons learned thereof.
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Affiliation(s)
- Ashish Agarwal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepankar Bansal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Vijai William
- Division of Pediatric Critical Care, Department of Critical Care, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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14
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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15
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Ingrosso DMF, Quarta MT, Quarta A, Chiarelli F. Prevention of Type 1 Diabetes in Children: A Worthy Challenge? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5962. [PMID: 37297566 PMCID: PMC10252671 DOI: 10.3390/ijerph20115962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/19/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Nowadays, the development of new immuno-therapeutic drugs has made it possible to alter the course of many autoimmune diseases. Type 1 diabetes is a chronic disease with a progressive dependence on exogenous insulin administration. The ability to intercept individuals at high risk of developing type 1 diabetes is the first step toward the development of therapies that can delay the process of β-cell destruction, thus permitting a better glycemic control and reducing the incidence of ketoacidosis. The knowledge of the main pathogenetic mechanisms underlying the three stages of the disease may be helpful to identify the best immune therapeutic approach. In this review, we aim to give an overview of the most important clinical trials conducted during the primary, secondary and tertiary phases of prevention.
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Affiliation(s)
| | | | | | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti, Via dei Vestini, 66100 Chieti, Italy
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16
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Passanisi S, Salzano G, Basile P, Bombaci B, Caime F, Rulli I, Valenzise M, Gitto E, Lombardo F. Prevalence and clinical features of severe diabetic ketoacidosis treated in pediatric intensive care unit: a 5-year monocentric experience. Ital J Pediatr 2023; 49:58. [PMID: 37210518 PMCID: PMC10199737 DOI: 10.1186/s13052-023-01448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/23/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the most alarming concerns in the management of type 1 diabetes (T1D) in pediatric age. Prevalence of DKA at the onset of diabetes ranges from 30 to 40%. In selected cases of severe DKA, admission to pediatric intensive care unit (PICU) should be considered. METHODS This study aims to assess the prevalence of severe DKA treated in PICU in our 5-year monocentric experience. Secondary outcome of the study was to describe the main demographical and clinical features of individuals who required admission to PICU. All clinical data were collected by retrospectively reviewing the electronic medical records of children and adolescents with diabetes hospitalized in our University Hospital from January 2017 to December 2022. RESULTS During the study period, 103 children and adolescents were newly diagnosed with T1D. Among these, 51.5% presented clinical criteria for DKA and almost 10% needed to be treated in PICU. A higher rate of new T1D diagnoses was observed in 2021, as well as episodes of severe DKA being more frequent than in previous years. Due to severe clinical manifestations of DKA, 10 subjects (9.7%) with T1D onset needed to be treated in PICU. Of these, four children were younger than 5. The great majority came from a low household income and some of them had also immigrant background. The most common complication of DKA was acute kidney injury presented by four children. Other complications were cerebral edema, papilledema and acute esophageal necrosis. A 15-year-old girl had deep vein thrombosis (DVT) that evolved into multiple organ failure leading to death. CONCLUSIONS Our findings demonstrated that severe DKA is still quite common in children and adolescents at T1D onset, especially in some areas such as Southern Italy. Public awareness campaigns should be increasingly promoted to facilitate the recognition of early symptoms of diabetes and to reduce morbidity and mortality related to DKA.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy.
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Pietro Basile
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Flavia Caime
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Immacolata Rulli
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
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17
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Gregg EW, Buckley J, Ali MK, Davies J, Flood D, Mehta R, Griffiths B, Lim LL, Manne-Goehler J, Pearson-Stuttard J, Tandon N, Roglic G, Slama S, Shaw JE. Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact. Lancet 2023; 401:1302-1312. [PMID: 36931289 PMCID: PMC10420388 DOI: 10.1016/s0140-6736(23)00001-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/17/2022] [Accepted: 12/20/2022] [Indexed: 03/15/2023]
Abstract
The Global Diabetes Compact is a WHO-driven initiative uniting stakeholders around goals of reducing diabetes risk and ensuring that people with diabetes have equitable access to comprehensive, affordable care and prevention. In this report we describe the development and scientific basis for key health metrics, coverage, and treatment targets accompanying the Compact. We considered metrics across four domains: factors at a structural, system, or policy level; processes of care; behaviours and biomarkers such as glycated haemoglobin (HbA1c); and health events and outcomes; and three risk tiers (diagnosed diabetes, high risk, or whole population), and reviewed and prioritised them according to their health importance, modifiability, data availability, and global inequality. We reviewed the global distribution of each metric to set targets for future attainment. This process led to five core national metrics and target levels for UN member states: (1) of all people with diabetes, at least 80% have been clinically diagnosed; and, for people with diagnosed diabetes, (2) 80% have HbA1c concentrations below 8·0% (63·9 mmol/mol); (3) 80% have blood pressure lower than 140/90 mm Hg; (4) at least 60% of people 40 years or older are receiving therapy with statins; and (5) each person with type 1 diabetes has continuous access to insulin, blood glucose meters, and test strips. We also propose several complementary metrics that currently have limited global coverage, but warrant scale-up in population-based surveillance systems. These include estimation of cause-specific mortality, and incidence of end-stage kidney disease, lower-extremity amputations, and incidence of diabetes. Primary prevention of diabetes and integrated care to prevent long-term complications remain important areas for the development of new metrics and targets. These metrics and targets are intended to drive multisectoral action applied to individuals, health systems, policies, and national health-care access to achieve the goals of the Global Diabetes Compact. Although ambitious, their achievement can result in broad health benefits for people with diabetes.
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Affiliation(s)
- Edward W Gregg
- School of Population Health, RCSI, University of Medicine and Health Sciences, Dublin, Ireland; School of Public Health, Imperial College London, London, UK.
| | - James Buckley
- School of Public Health, Imperial College London, London, UK
| | - Mohammed K Ali
- Hubert Department of Global Health and Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Roopa Mehta
- Unidad de Investigacion en Enfermedades Metabolicas, Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ben Griffiths
- School of Public Health, Imperial College London, London, UK
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Jonathan Pearson-Stuttard
- School of Public Health, Imperial College London, London, UK; Health Analytics, Lane Clark & Peacock, London, UK
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Gojka Roglic
- Department of Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Slim Slama
- Department of Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute and School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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18
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Tatovic D, Narendran P, Dayan CM. A perspective on treating type 1 diabetes mellitus before insulin is needed. Nat Rev Endocrinol 2023; 19:361-370. [PMID: 36914759 DOI: 10.1038/s41574-023-00816-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 03/16/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is a progressive autoimmune disease that starts long before a clinical diagnosis is made. The American Diabetes Association recognizes three stages: stage 1 (normoglycaemic and positive for autoantibodies to β-cell antigens); stage 2 (asymptomatic with dysglycaemia); and stage 3, which is defined by glucose levels consistent with the definition of diabetes mellitus. This Perspective focuses on the management of the proportion of individuals with early stage 3 T1DM who do not immediately require insulin; a stage we propose should be termed stage 3a. To date, this period of non-insulin-dependent T1DM has been largely unrecognized. Importantly, it represents a window of opportunity for intervention, as remaining at this stage might delay the need for insulin by months or years. Extending the insulin-free period and/or avoiding unnecessary insulin therapy are important goals, as there is no risk of hypoglycaemia during this period and the adherence burden on patients of glycaemic monitoring and daily adjustments for diet and exercise is substantially reduced. Recognizing the pressing need for guidance on adequate management of children and adults with stage 3a T1DM, we present our perspective on the subject, which needs to be tested in formal and adequately powered clinical trials.
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Affiliation(s)
- Danijela Tatovic
- Diabetes Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Colin M Dayan
- Diabetes Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.
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19
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Baechle C, Eckert A, Kamrath C, Neu A, Manuwald U, Thiele-Schmitz S, Weidler O, Knauer-Fischer S, Rosenbauer J, Holl RW. Incidence and presentation of new-onset type 1 diabetes in children and adolescents from Germany during the COVID-19 pandemic 2020 and 2021: Current data from the DPV Registry. Diabetes Res Clin Pract 2023; 197:110559. [PMID: 36758641 DOI: 10.1016/j.diabres.2023.110559] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
AIMS To determine whether the incidence of type 1 diabetes mellitus (T1D), autoantibody-negative diabetes, and diabetic ketoacidosis (DKA) at diabetes onset in 2020 and 2021 changed when compared to long-standing trends. METHODS Our study is based on diabetes manifestation data of the 0.5-<18-year-old children/adolescents from the German multicenter Diabetes Prospective Follow-up Registry. Based on long-term pre-pandemic trends from 2011 to 2019, we estimated adjusted incidence rate ratios (IRR) for T1D and DKA, and prevalence rate ratios (PRR) regarding autoantibody status with 95 % confidence intervals (CI) for the years 2020 and 2021 (observed versus predicted rates), using multivariable negative binomial or beta-binomial regression, respectively. RESULTS We analyzed data of 30,840 children and adolescents with new-onset T1D. The observed incidences were significantly higher than the predicted incidences (IRR2020 1.13 [1.08-1.19]; IRR2021 1.20 [1.15-1.26]). The prevalence of autoantibody-negative diabetes did not change (PRR2020 0.91 [0.75-1.10]; PRR2021 1.03 [0.86-1.24]). The incidence of DKA during the pandemic was higher than predicted (IRR2020 1.34 [1.23-1.46]; IRR2021 1.37 [1.26-1.49]). CONCLUSIONS An increase in the incidences of T1D and DKA, but not of autoantibody-negative diabetes was observed during both pandemic years. Further monitoring and efforts for DKA prevention at onset are necessary.
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Affiliation(s)
- C Baechle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, D-85764 Munich-Neuherberg, Germany.
| | - A Eckert
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, D-85764 Munich-Neuherberg, Germany.
| | - C Kamrath
- Justus Liebig University, Center of Child and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetology, Feulgenstraße 10-12, D-35392 Giessen, Germany.
| | - A Neu
- University Hospital Tübingen, Clinic for Paediatrics and Youth Medicine, Hoppe-Seyler-Straße 1, D-72076 Tübingen, Germany.
| | - U Manuwald
- Technische Universität Dresden, Faculty of Medicine "Carl Gustav Carus", Institute and Policlinic of Occupational and Social Medicine, Health Sciences/Public Health, Fetscherstraße 74, D-01307 Dresden, Germany.
| | - S Thiele-Schmitz
- St. Louise Women's and Children's Hospital, Diabetes Center for Children and Adolescents, Husener Straße 81, D-33098 Paderborn, Germany.
| | - O Weidler
- Elbe Kliniken Stade - Buxtehude, Bremervörder Straße 111, D-21682 Stade, Germany.
| | - S Knauer-Fischer
- University Hospital Mannheim, Clinic for Pediatric and Adolescent Medicine, Division of Endocrinology and Diabetology, Theodor-Kutzer-Ufer 1, D-368167 Mannheim, Germany.
| | - J Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, D-85764 Munich-Neuherberg, Germany.
| | - R W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, D-85764 Munich-Neuherberg, Germany.
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20
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Seewoodhary J, Silveira A. Teplizumab – preventative approaches to type 1 diabetes mellitus. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Jason Seewoodhary
- General Practitioner, NHS Northwest London, Brent Integrated Health Board UK
| | - Angela Silveira
- Resident in Public Health & Preventive Medicine, Saskatchewan Health Authority Canada
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21
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Odeh R, Gharaibeh L, Daher A, Albaramki J, Ashour B, Barakat FA, Dahabreh D, Hadadin H, Melhem T, Alassaf A. Frequency, Clinical Characteristics and Predictors of Ketoacidosis at Diagnosis of Type One Diabetes Mellitus in Children and Adolescents from Jordan. J Clin Res Pediatr Endocrinol 2023; 15:46-54. [PMID: 36264035 PMCID: PMC9976172 DOI: 10.4274/jcrpe.galenos.2022.2022-5-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Data regarding diabetic ketoacidosis (DKA) at diagnosis of type one diabetes (T1D) in developing countries are scarce. The aim of this study was to describe the frequency of DKA at the onset of T1D in children and adolescents in Jordan and to compare the clinical and biochemical characteristics between the group that presented with DKA and the group that did not. METHODS The records of 341 children and adolescents, less than sixteen years of age, who were diagnosed with T1D between 2015 and 2019 were evaluated retrospectively. RESULTS Of all the children diagnosed with T1D, 108 (31.7%) presented with DKA. The majority had mild or moderate DKA (38% and 33.3% respectively). Higher paternal education levels were associated with a lower probability of presenting with DKA (p=0.043). A family history of T1D had a protective effect on the occurrence of DKA (Odds ratio=2.138; 95% confidence interval=1.167-3.917, p=0.014). Patients with celiac disease and higher HbA1c levels were more likely to experience recurrent episodes of DKA, (p=0.004 and 0.011, respectively). CONCLUSION In Jordan, the rate of DKA at presentation of T1D remains high. Prevention campaigns are needed to increase diabetes awareness among the public and healthcare providers.
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Affiliation(s)
- Rasha Odeh
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan,* Address for Correspondence: University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan Phone: +962799178517 E-mail:
| | - Lobna Gharaibeh
- AI-Ahliyya Amman University, Faculty of Pharmacy, Pharmacological and Diagnostic Research Center, Amman, Jordan
| | - Amirah Daher
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| | - Jumana Albaramki
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| | - Bahaa Ashour
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| | - Fatima Al Barakat
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| | - Dina Dahabreh
- University of Jordan, School of Medicine, Amman, Jordan
| | - Hiba Hadadin
- University of Jordan, School of Medicine, Amman, Jordan
| | - Tala Melhem
- University of Jordan, School of Medicine, Amman, Jordan
| | - Abeer Alassaf
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
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22
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Boltri JM, Tracer H, Strogatz D, Idzik S, Schumacher P, Fukagawa N, Leake E, Powell C, Shell D, Wu S, Herman WH. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Prevent Diabetes in People With Prediabetes. Diabetes Care 2023; 46:e39-e50. [PMID: 36701590 PMCID: PMC9887613 DOI: 10.2337/dc22-0620] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/03/2022] [Indexed: 01/27/2023]
Abstract
Individuals with an elevated fasting glucose level, elevated glucose level after glucose challenge, or elevated hemoglobin A1c level below the diagnostic threshold for diabetes (collectively termed prediabetes) are at increased risk for type 2 diabetes. More than one-third of U.S. adults have prediabetes but fewer than one in five are aware of the diagnosis. Rigorous scientific research has demonstrated the efficacy of both intensive lifestyle interventions and metformin in delaying or preventing progression from prediabetes to type 2 diabetes. The National Clinical Care Commission (NCCC) was a federal advisory committee charged with evaluating and making recommendations to improve federal programs related to the prevention of diabetes and its complications. In this article, we describe the recommendations of an NCCC subcommittee that focused primarily on prevention of type 2 diabetes in people with prediabetes. These recommendations aim to improve current federal diabetes prevention activities by 1) increasing awareness of and diagnosis of prediabetes on a population basis; 2) increasing the availability of, referral to, and insurance coverage for the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program; 3) facilitating Food and Drug Administration review and approval of metformin for diabetes prevention; and 4) supporting research to enhance the effectiveness of diabetes prevention. Cognizant of the burden of type 1 diabetes, the recommendations also highlight the importance of research to advance our understanding of the etiology of and opportunities for prevention of type 1 diabetes.
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Affiliation(s)
| | - Howard Tracer
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD
| | | | - Shannon Idzik
- School of Nursing, University of Maryland, Baltimore, MD
| | - Pat Schumacher
- Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, GA
| | | | - Ellen Leake
- Juvenile Diabetes Research Foundation, Jackson, MS
| | - Clydette Powell
- School of Medicine and Health Services, George Washington University, Washington, DC
| | | | - Samuel Wu
- U.S. Office of Minority Health, Rockville, MD
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23
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Quinn LM, Rashid R, Narendran P, Shukla D. Screening children for presymptomatic type 1 diabetes. Br J Gen Pract 2023; 73:36-39. [PMID: 36543557 PMCID: PMC9799351 DOI: 10.3399/bjgp23x731709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lauren M Quinn
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham
| | - Rajeeb Rashid
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow; Consultant Paediatric Diabetologist, Children's & Young People's Diabetes Service, Royal Hospital for Children, Glasgow
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham; Consultant Diabetologist, Department of Diabetes, University Hospitals of Birmingham, Birmingham
| | - David Shukla
- Clinical Research Lead for Primary Care (West Midlands), National Institute for Health and Care Research; Clinical Research Fellow, Institute of Applied Health Research, University of Birmingham, Birmingham
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24
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Clapin HF, Earnest A, Colman PG, Davis EA, Jefferies C, Anderson K, Chee M, Bergman P, de Bock M, Kao KT, Fegan PG, Holmes-Walker DJ, Johnson S, King BR, Mok MT, Narayan K, Peña Vargas AS, Sinnott R, Wheeler BJ, Zimmermann A, Craig ME, Couper JJ, Andrikopoulos S, Barrett H, Batch J, Cameron F, Conwell L, Cotterill A, Cooper C, Donaghue K, Fairchild J, Fourlanos S, Glastras S, Goss P, Gray L, Hamblin S, Hofman P, Huynh T, James S, Jones T, Lafferty A, Martin M, McCrossin R, Neville K, Pascoe M, Paul R, Pawlak D, Phillips L, Price D, Rodda C, Simmons D, Smart C, Stone M, Stranks S, Tham E, Ward G, Woodhead H. Diabetic Ketoacidosis at Onset of Type 1 Diabetes and Long-term HbA1c in 7,961 Children and Young Adults in the Australasian Diabetes Data Network. Diabetes Care 2022; 45:2918-2925. [PMID: 36749868 DOI: 10.2337/dc22-0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The relationship between diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes and long-term glycemic control varies between studies. We aimed, firstly, to characterize the association of DKA and its severity with long-term HbA1c in a large contemporary cohort, and secondly, to identify other independent determinants of long-term HbA1c. RESEARCH DESIGN AND METHODS Participants were 7,961 children and young adults diagnosed with type 1 diabetes by age 30 years from 2000 to 2019 and followed prospectively in the Australasian Diabetes Data Network (ADDN) until 31 December 2020. Linear mixed-effect models related variables to HbA1c. RESULTS DKA at diagnosis was present in 2,647 participants (33.2%). Over a median 5.6 (interquartile range 3.2, 9.4) years of follow-up, participants with severe, but not moderate or mild, DKA at diagnosis had a higher mean HbA1c (+0.23%, 95% CI 0.11,0.28; [+2.5 mmol/mol, 95% CI 1.4,3.6]; P < 0.001) compared with those without DKA. Use of continuous subcutaneous insulin infusion (CSII) was independently associated with a lower HbA1c (-0.28%, 95% CI -0.31, -0.25; [-3.1 mmol/mol, 95% CI -3.4, -2.8]; P < 0.001) than multiple daily injections, and CSII use interacted with severe DKA to lower predicted HbA1c. Indigenous status was associated with higher HbA1c (+1.37%, 95% CI 1.15, 1.59; [+15.0 mmol/mol, 95% CI 12.6, 17.4]; P < 0.001), as was residing in postcodes of lower socioeconomic status (most vs. least disadvantaged quintile +0.43%, 95% CI 0.34, 0.52; [+4.7 mmol/mol, 95% CI 3.4, 5.6]; P < 0.001). CONCLUSIONS Severe, but not mild or moderate, DKA at diagnosis was associated with a marginally higher HbA1c over time, an effect that was modified by use of CSII. Indigenous status and lower socioeconomic status were independently associated with higher long-term HbA1c.
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Affiliation(s)
- Helen F Clapin
- Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | - Peter G Colman
- Royal Melbourne Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth A Davis
- Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | | | - Melissa Chee
- JDRF Australia, St Leonards, New South Wales, Australia
| | - Philip Bergman
- Monash University, Clayton, Victoria, Australia.,Monash Children's Hospital, Clayton, Victoria, Australia
| | - Martin de Bock
- Canterbury District Health Board, Christchurch, New Zealand.,Christchurch School of Medicine, University of Otago, Otago, New Zealand
| | - Kung-Ting Kao
- The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - P Gerry Fegan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Stephanie Johnson
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Bruce R King
- John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
| | | | - Kruthika Narayan
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Alexia S Peña Vargas
- Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
| | | | - Benjamin J Wheeler
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin Central, Dunedin, New Zealand
| | - Anthony Zimmermann
- Lyell McEwin & Modbury Hospitals, Elizabeth Vale, South Australia, Australia
| | - Maria E Craig
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny J Couper
- Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
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25
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Biester T, Danne T. The Role of Sodium-Glucose Cotransporter Inhibitors with AID Systems in Diabetes Treatment: Is Continuous Ketone Monitoring the Solution? Diabetes Technol Ther 2022; 24:925-928. [PMID: 35960269 DOI: 10.1089/dia.2022.0268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Torben Biester
- Diabetes Center for Children and Adolescents, AUF DER BULT, Hannover, Germany
| | - Thomas Danne
- Diabetes Center for Children and Adolescents, AUF DER BULT, Hannover, Germany
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26
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Rugg-Gunn CEM, Dixon E, Jorgensen AL, Usher-Smith JA, Marcovecchio ML, Deakin M, Hawcutt DB. Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients: A Systematic Review. JAMA Pediatr 2022; 176:1248-1259. [PMID: 36215053 DOI: 10.1001/jamapediatrics.2022.3586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Presenting with diabetic ketoacidosis (DKA) at onset of type 1 diabetes (T1D) remains a risk. Following a 2011 systematic review, considerable additional articles have been published, and the review required updating. OBJECTIVE To evaluate factors associated with DKA at the onset of T1D among pediatric patients. EVIDENCE REVIEW In this systematic review, PubMed, Embase, Scopus, CINAHL, Web of Science, and article reference lists were searched using the population, intervention, comparison, outcome search strategy for primary research studies on DKA and T1D onset among individuals younger than 18 years that were published from January 2011 to November 2021. These studies were combined with a 2011 systematic review on the same topic. Data were pooled using a random-effects model. FINDINGS A total of 2565 articles were identified; 149 were included, along with 46 from the previous review (total 195 articles). Thirty-eight factors were identified and examined for their association with DKA at T1D onset. Factors associated with increased risk of DKA were younger age at T1D onset (<2 years vs ≥2 years; odds ratio [OR], 3.51; 95% CI, 2.85-4.32; P < .001), belonging to an ethnic minority population (OR, 0.40; 95% CI, 0.21-0.74; P = .004), and family history of T1D (OR, 0.46; 95% CI, 0.37-0.57; P < .001), consistent with the 2011 systematic review. Some factors that were not associated with DKA in the 2011 systematic review were associated with DKA in the present review (eg, delayed diagnosis: OR, 2.27; 95% CI, 1.72-3.01; P < .001). Additional factors associated with risk of DKA among patients with new-onset T1D included participation in screening programs (OR, 0.35; 95% CI, 0.21-0.59; P < .001) and presentation during the COVID-19 pandemic (OR, 2.32; 95% CI, 1.76-3.06; P < .001). CONCLUSIONS AND RELEVANCE In this study, age younger than 2 years at T1D onset, belonging to an ethnic minority population, delayed diagnosis or misdiagnosis, and presenting during the COVID-19 pandemic were associated with increased risk of DKA. Factors associated with decreased risk of DKA included greater knowledge of key signs or symptoms of DKA, such as a family history of T1D or participation in screening programs. Future work should focus on identifying and implementing strategies related to these factors to reduce risk of DKA among new patients with T1D.
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Affiliation(s)
| | - Eleanor Dixon
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Andrea L Jorgensen
- Department of Biostatistics, University of Liverpool, Liverpool, England
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, England
| | | | - Mark Deakin
- Alder Hey Children's Hospital, Liverpool, England
| | - Daniel B Hawcutt
- NIHR Alder Hey Clinical Research Facility, Liverpool, England.,Department of Women's and Children's Health, University of Liverpool, Liverpool, England
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27
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Bratina N, Auzanneau M, Birkebæk N, de Beaufort C, Cherubini V, Craig ME, Dabelea D, Dovc K, Hofer SE, Holl RW, Jensen ET, Mul D, Nagl K, Robinson H, Schierloh U, Svensson J, Tiberi V, Veeze HJ, Warner JT, Donaghue KC. Differences in retinopathy prevalence and associated risk factors across 11 countries in three continents: A cross-sectional study of 156,090 children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1656-1664. [PMID: 36097824 PMCID: PMC9771999 DOI: 10.1111/pedi.13416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/30/2022] [Accepted: 09/07/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To examine the prevalence, time trends, and risk factors of diabetic retinopathy (DR) among youth with type 1 diabetes (T1D) from 11 countries (Australia, Austria, Denmark, England, Germany, Italy, Luxemburg, Netherlands, Slovenia, United States, and Wales). SUBJECTS AND METHODS Data on individuals aged 10-21 years with T1D for >1 year during the period 2000-2020 were analyzed. We used a cross-sectional design using the most recent year of visit to investigate the time trend. For datasets with longitudinal data, we aggregated the variables per participant and observational year, using data of the most recent year to take the longest observation period into account. DR screening was performed through quality assured national screening programs. Multiple logistic regression models adjusted for the year of the eye examination, age, gender, minority status, and duration of T1D were used to evaluate clinical characteristics and the risk of DR. RESULTS Data from 156,090 individuals (47.1% female, median age 15.7 years, median duration of diabetes 5.2 years) were included. Overall, the unadjusted prevalence of any DR was 5.8%, varying from 0.0% (0/276) to 16.2% between countries. The probability of DR increased with longer disease duration (aORper-1-year-increase = 1.04, 95% CI: 1.03-1.04, p < 0.0001), and decreased over time (aORper-1-year-increase = 0.99, 95% CI: 0.98-1.00, p = 0.0093). Evaluating possible modifiable risk factors in the exploratory analysis, the probability of DR increased with higher HbA1c (aORper-1-mmol/mol-increase-in-HbA1c = 1.03, 95% CI: 1.03-1.03, p < 0.0001) and was higher among individuals with hypertension (aOR = 1.24, 95% CI: 1.11-1.38, p < 0.0001) and smokers (aOR = 1.30, 95% CI: 1.17-1.44, p < 0.0001). CONCLUSIONS The prevalence of DR in this large cohort of youth with T1D varied among countries, increased with diabetes duration, decreased over time, and was associated with higher HbA1c, hypertension, and smoking.
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Affiliation(s)
- Natasa Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's HospitalUMC LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Marie Auzanneau
- Institute of Epidemiology and Medical BiometryZIBMT, University of UlmUlmGermany
- German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Niels Birkebæk
- Department of Pediatric and Adolescents and Steno Diabetes Center, AarhusAarhus University HospitalAarhusDenmark
| | - Carine de Beaufort
- Department of Pediatric Diabetes and EndocrinologyCentre HospitalierLuxembourgLuxembourg
- Department of Pediatric EndocrinologyUZ‐VUBBrusselsBelgium
| | | | - Maria E. Craig
- The Children's Hospital at WestmeadSydneyAustralia
- University of SydneySydneyAustralia
- University of New South WalesSydneyAustralia
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's HospitalUMC LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Sabine E. Hofer
- Department of Pediatrics 1Medical University of InnsbruckInnsbruckAustria
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical BiometryZIBMT, University of UlmUlmGermany
- German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Elizabeth T. Jensen
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Dick Mul
- DiabeterCenter for Pediatric and Adult Diabetes Care and ResearchRotterdamThe Netherlands
| | - Katrin Nagl
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Holly Robinson
- Department of Science and ResearchRoyal College of Paediatrics and Child HealthLondonUK
| | - Ulrike Schierloh
- Department of Pediatric Diabetes and EndocrinologyCentre HospitalierLuxembourgLuxembourg
| | - Jannet Svensson
- Department of Pediatric and AdolescentsCopenhagen University HospitalHerlev & GentofteDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Valentina Tiberi
- Department of Women's and Children's HealthSalesi HospitalAnconaItaly
| | - Henk J. Veeze
- DiabeterCenter for Pediatric and Adult Diabetes Care and ResearchRotterdamThe Netherlands
| | - Justin T. Warner
- Department of Paediatric EndocrinologyChildren's Hospital for WalesCardiffUK
| | - Kim C. Donaghue
- The Children's Hospital at WestmeadSydneyAustralia
- University of SydneySydneyAustralia
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28
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Wentworth JM, Oakey H, Craig ME, Couper JJ, Cameron FJ, Davis EA, Lafferty AR, Harris M, Wheeler BJ, Jefferies C, Colman PG, Harrison LC. Decreased occurrence of ketoacidosis and preservation of beta cell function in relatives screened and monitored for type 1 diabetes in Australia and New Zealand. Pediatr Diabetes 2022; 23:1594-1601. [PMID: 36175392 PMCID: PMC9772160 DOI: 10.1111/pedi.13422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/09/2022] [Accepted: 09/24/2022] [Indexed: 12/29/2022] Open
Abstract
AIMS Islet autoantibody screening of infants and young children in the Northern Hemisphere, together with semi-annual metabolic monitoring, is associated with a lower risk of ketoacidosis (DKA) and improved glucose control after diagnosis of clinical (stage 3) type 1 diabetes (T1D). We aimed to determine if similar benefits applied to older Australians and New Zealanders monitored less rigorously. METHODS DKA occurrence and metabolic control were compared between T1D relatives screened and monitored for T1D and unscreened individuals diagnosed in the general population, ascertained from the Australasian Diabetes Data Network. RESULTS Between 2005 and 2019, 17,105 relatives (mean (SD) age 15.7 (10.8) years; 52% female) were screened for autoantibodies against insulin, glutamic acid decarboxylase, and insulinoma-associated protein 2. Of these, 652 screened positive to a single and 306 to multiple autoantibody specificities, of whom 201 and 215, respectively, underwent metabolic monitoring. Of 178 relatives diagnosed with stage 3 T1D, 9 (5%) had DKA, 7 of whom had not undertaken metabolic monitoring. The frequency of DKA in the general population was 31%. After correction for age, sex and T1D family history, the frequency of DKA in screened relatives was >80% lower than in the general population. HbA1c and insulin requirements following diagnosis were also lower in screened relatives, consistent with greater beta cell reserve. CONCLUSIONS T1D autoantibody screening and metabolic monitoring of older children and young adults in Australia and New Zealand, by enabling pre-clinical diagnosis when beta cell reserve is greater, confers protection from DKA. These clinical benefits support ongoing efforts to increase screening activity in the region and should facilitate the application of emerging immunotherapies.
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Affiliation(s)
- John M Wentworth
- Department of Population Health and Immunity, Walter and Eliza Hall Institute, Parkville, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Australia
| | - Helena Oakey
- Robinson Research Institute, University of Adelaide, South Australia
| | - Maria E Craig
- School of Women’s and Children’s Health, University of New South Wales, Australia
- Children’s Hospital at Westmead, Westmead, Australia
- Charles Perkins Centre Westmead, University of Sydney, Australia
| | - Jennifer J Couper
- Department of Diabetes and Endocrinology, Women’s and Children’s Hospital, North Adelaide, South Australia
| | | | | | | | - Mark Harris
- Queensland Children’s Hospital, South Brisbane, Australia
| | - Benjamin J Wheeler
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, New Zealand
- Department of Paediatrics, Southern District Health Board, Dunedin, New Zealand
| | - Craig Jefferies
- Starship Children’s Health Liggins institute and Department of Paediatrics, University of Auckland, New Zealand
| | - Peter G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Australia
| | - Leonard C Harrison
- Department of Population Health and Immunity, Walter and Eliza Hall Institute, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Australia
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Birkebaek NH, Kamrath C, Grimsmann JM, Aakesson K, Cherubini V, Dovc K, de Beaufort C, Alonso GT, Gregory JW, White M, Skrivarhaug T, Sumnik Z, Jefferies C, Hörtenhuber T, Haynes A, De Bock M, Svensson J, Warner JT, Gani O, Gesuita R, Schiaffini R, Hanas R, Rewers A, Eckert AJ, Holl RW, Cinek O. 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. Lancet Diabetes Endocrinol 2022; 10:786-794. [PMID: 36202118 PMCID: PMC9597608 DOI: 10.1016/s2213-8587(22)00246-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Niels H Birkebaek
- Department of Pediatrics and Adolescent Medicine and Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
| | - Clemens Kamrath
- Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Karin Aakesson
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC Ljubljana, University Children's Hospital, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg
| | - Guy T Alonso
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Mary White
- 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
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czechia; University Hospital Motol, Prague, Czechia
| | - Craig Jefferies
- Starship Children's Health and University of Auckland, Auckland, New Zealand
| | - Thomas Hörtenhuber
- Department of Pediatrics and Adolescent Medicine, Kepler University Clinic, Linz, Austria
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Martin De Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Jannet Svensson
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Justin T Warner
- Department of Paediatric Endocrinology and Diabetes, Children's Hospital for Wales, Cardiff, UK
| | - Osman Gani
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | | | - Ragnar Hanas
- NU Hospital Group, Uddevalla, Trollhättan, Sweden; Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Arleta Rewers
- Denver Scool of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czechia; University Hospital Motol, Prague, Czechia
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30
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Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 2022; 23:835-856. [PMID: 36250645 DOI: 10.1111/pedi.13406] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Nicole Glaser
- Department of Pediatrics, Section of Endocrinology, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Austria Medical University of Graz, Graz, Austria
| | - Leena Priyambada
- Division of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Arleta Rewers
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Sylvia Estrada
- Department of Pediatrics, Division of Endocrinology and Metabolism, University of the Philippines, College of Medicine, Manila, Philippines
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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31
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Misra S. Rise in diabetic ketoacidosis during the COVID-19 pandemic: several questions remain. Lancet Diabetes Endocrinol 2022; 10:763-765. [PMID: 36202117 PMCID: PMC9529215 DOI: 10.1016/s2213-8587(22)00272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK; Department of Diabetes, Endocrinology and Metabolism, Imperial College Healthcare NHS Trust, London, UK.
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32
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Vitamin D Repletion and AA/EPA Intake in Children with Type 1 Diabetes: Influences on Metabolic Status. Nutrients 2022; 14:nu14214603. [PMID: 36364863 PMCID: PMC9655859 DOI: 10.3390/nu14214603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Our study aimed to show a relationship between metabolic control, vitamin D status (25OHD), and arachidonic acid (AA)/eicosapentaenoic acid (EPA) ratio in children with type 1 diabetes (T1D). The secondary aim was to evaluate dietary intake and the presence of ketoacidosis (DKA) at the onset of T1D. Methods: A cohort of 40 children with T1D was recruited, mean age 9.7 years (7.1; 13), with onset of T1D in the last 5 years: some at onset (n: 20, group A) and others after 18.0 ± 5 months (n: 20; group B). Twenty healthy children were compared as control subjects (CS). Dietary intakes were assessed through a diary food frequency questionnaire. Moreover, dried blood spots were used to test AA/EPA ratio by gas chromatography. Results: T1D children had a lower percentage of sugar intake (p < 0.02) than CS. Furthermore, group B introduced a greater amount of AA with the diet (g/day; p < 0.05) than CS (p < 0.01) and group A (p < 0.01). Children with an AA/EPA ratio ≤ 22.5 (1st quartile) required a lower insulin demand and had higher 25OHD levels than those who were in the higher quartiles (p < 0.05). Subjects with DKA (9/40) had levels of 25OHD (p < 0.05) and C-peptide (p < 0.05) lower than those without DKA. Moreover, analyzing the food questionnaire in group A, subjects with DKA showed a lower intake of proteins, sugars, fiber (g/day; p< 0.05), vitamin D, EPA, and DHA (g/day; p < 0.01) compared to subjects without DKA. Non-linear associations between vitamin D intake (p < 0.0001; r2:0.580) and linear between EPA intake and C-peptide (p < 0.05; r: 0.375) were found in all subjects. Conclusions: The study shows a relationship between vitamin D status, AA/EPA ratio, and metabolic state, probably due to their inflammatory and immune mechanisms. A different bromatological composition of the diet could impact the severity of the onset.
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33
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Albuali WH, Al-Qahtan MH. Diabetic Ketoacidosis and its Severity Predictors in Type 1 Diabetic Children; A 10-year Experience of A Teaching Hospital in Saudi Arabia. Rev Diabet Stud 2022; 18:146-151. [PMID: 36309773 PMCID: PMC9652709 DOI: 10.1900/rds.2022.18.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE: Our objective was to determine the trend and precipitating factors of the severity of diabetic ketoacidosis (DKA) in the population admitted to the Pediatric Intensive Care Unit (PICU) in a large teaching hospital in the Eastern region of Saudi Arabia. METHODS: We conducted a retrospective, analytical study at King Fahad Hospital, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia. We retrieved the complete medical records of 2234 children who were admitted to the PICU during the 10-year period of 2010 through 2019. The children included those with polydipsia, polyurea, abdominal pain, vomiting, dehydration, and weight loss, as well as breathing disturbances due to acidosis and CNS issues such as lethargy or coma and elevated blood glucose level, > 200 mg/dL [> 11.1 mmol/L], venous pH 7.3, serum total CO2 15 mmol/L, and blood- hydroxybutyrate concentration 3 mmol/L or moderate or severe ketonuria. RESULTS: Out of 2234 PICU admissions, 211 (9.4%) were diagnosed with DKA. A persistent increase in the rate of DKA ended up at 14.1% in 2019 (p = .005). The incidence of DKA was 88/2234 (3.93%). The severity of DKA was as follows: 130 (61.6%) had severe and 81 (38.4%) had moderate DKA. Excessive sweet intake without adding insulin in 83 (39.3%) patients and unhealthy lifestyles (35.1%) were the best predictors of severe DKA (p = .001). CONCLUSION: Over a 10-year period, the DKA pattern was persistently rising and slightly falling, which ended up at the significantly highest rate of 14.1% in 2019. URTI, pneumonia, unhealthy lifestyle, and excess sweet intake were significant precipitating factors associated with severe DKA.
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34
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Poon SWY, Tung JYL, Wong WHS, Cheung PT, Fu ACC, Pang GSW, To SWY, Wong LM, Wong WY, Chan SY, Yau HC, See WS, But BWM, Wong SMY, Lo PWC, Ng KL, Chan KT, Lam HY, Wong SWC, Lam YY, Yuen HW, Chung JYK, Lee CY, Tay MK, Kwan EYW. Diabetic ketoacidosis in children with new-onset type 1 diabetes mellitus: demographics, risk factors and outcome: an 11 year review in Hong Kong. J Pediatr Endocrinol Metab 2022; 35:1132-1140. [PMID: 36001345 DOI: 10.1515/jpem-2022-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). The aim of this study is to analyze the incidence, clinical characteristics, management and outcome of children presenting with DKA in new-onset T1D from 2008 to 2018 in Hong Kong. METHODS Data was extracted from the Hong Kong Childhood Diabetes Registry. All subjects less than 18 years with newly diagnosed T1D from 1 January 2008 to 31 December 2018 managed in the public hospitals were included. Information on demographics, laboratory parameters, DKA-related complications and management were analyzed. RESULTS In the study period, there were 556 children with newly diagnosed T1D in our registry and 43.3% presented with DKA. The crude incidence rate of new-onset T1D with DKA was 1.79 per 100,000 persons/year (CI: 1.56-2.04). Subjects presenting with DKA were younger (9.5 ± 4.5 vs. 10.5 ± 4.4, p=0.01) and had shorter duration of symptoms (4.2 ± 5.9 days vs. 10.6 ± 17.1 days, p<0.01). Regarding management, up to 12.4% were given insulin boluses and 82.6% were started on insulin infusion 1 h after fluid resuscitation. The rate of cerebral edema was 0.8% and there was no mortality. CONCLUSIONS Younger age and shorter duration of symptoms were associated with DKA in new-onset T1D. Despite availability of international guidelines, there was inconsistency in acute DKA management. These call for a need to raise public awareness on childhood diabetes as well as standardization of practice in management of pediatric DKA in Hong Kong.
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Affiliation(s)
- Sarah Wing-Yiu Poon
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, P.R. China
| | - Joanna Yuet-Ling Tung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, P.R. China
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, P.R. China
| | - Pik-To Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, P.R. China
| | - Antony Chun-Cheung Fu
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, P.R. China
| | - Gloria Shir-Wey Pang
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, P.R. China.,Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, P.R. China
| | - Sharon Wing-Yan To
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, P.R. China
| | - Lap-Ming Wong
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, P.R. China
| | - Wai-Yu Wong
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, P.R. China
| | - Suk-Yan Chan
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong, P.R. China
| | - Ho-Chung Yau
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong, P.R. China
| | - Wing-Shan See
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, P.R. China
| | - Betty Wai-Man But
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, P.R. China
| | | | - Priscilla Wai-Chee Lo
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, P.R. China
| | - Kwok-Leung Ng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, P.R. China
| | - Kwong-Tat Chan
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, P.R. China
| | - Hi-Yuet Lam
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, P.R. China
| | - Sammy Wai-Chun Wong
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, P.R. China
| | - Yuen-Yu Lam
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, P.R. China
| | - Hoi-Wing Yuen
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, P.R. China
| | - Jacky Ying-Ki Chung
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong, P.R. China
| | - Ching-Yee Lee
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong, P.R. China
| | - Ming-Kut Tay
- Department of Paediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Hong Kong, P.R. China
| | - Elaine Yin-Wah Kwan
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, P.R. China
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Lek N, Manivong A, Rassavong K, Phommachack D, Toomey C, Ng SM. Type 1 diabetes in Laos, 2016-2021. Pediatr Diabetes 2022; 23:620-626. [PMID: 35598163 PMCID: PMC9545879 DOI: 10.1111/pedi.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/10/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Before 2016, no child was known to survive type 1 diabetes (T1D) in Laos, a lower-middle income country (LMIC) in South-east Asia. In partnership with the Laos government, a non-government organization (NGO) called Action4Diabetes (A4D) has since been providing insulin, blood glucose monitoring kits, HbA1c testing, and emergency hospital expenses for Laotian children and young people (CYP) with T1D, and education for healthcare professionals. Here, we report the demographics and clinical outcomes of the CYP with T1D enrolled in A4D's Clinic Support Programme. RESEARCH DESIGN AND METHODS We collated and analyzed data on all known CYP with T1D in Laos, including gender, age and presentation at diagnosis, duration of diabetes, hospital admissions, and glycemic control during follow-up. RESULTS Fifty-three CYP (30 male; 57%) were diagnosed with T1D at a mean age of 11.3 years. Thirty CYP (57%) presented in diabetic ketoacidosis (DKA) at diagnosis. As at 16 August 2021, mean duration of T1D was 2.3 years. Forty-five CYP (85%) remained on active follow-up. Mean HbA1c for all 53 CYP was 8.7% (72 mmol/mol). Average HbA1c for the CYP in the age ranges of 1-5 years, 6-10 years, 11-15 years, 16-20 years, and 21-25 years, was 7.9% (63 mmol/mol), 8.2% (66), 8.4% (68), 9.4% (79), and 8.4% (68), respectively. CONCLUSIONS This is the first report on the status of T1D care in Laos, achieved through close partnership between the government and an NGO from 2016 to 2021. More global efforts to improve T1D care outcomes in Laos and other LMICs are urgently needed.
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Affiliation(s)
- Ngee Lek
- Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
| | | | | | | | | | - Sze May Ng
- Southport and Ormskirk Hospital NHS TrustOrmskirkUK,Department of Women's and Children's HealthUniversity of LiverpoolLiverpoolUK
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36
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Lanzinger S, Zimmermann A, Ranjan AG, Gani O, Pons Perez S, Akesson K, Majidi S, Witsch M, Hofer S, Johnson S, Pilgaard KA, Kummernes SJ, Robinson H, Eeg-Olofsson K, Ebekozien O, Holl RW, Svensson J, Skrivarhaug T, Warner J, Craig ME, Maahs D. A collaborative comparison of international pediatric diabetes registries. Pediatr Diabetes 2022; 23:627-640. [PMID: 35561091 DOI: 10.1111/pedi.13362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/24/2022] [Accepted: 05/04/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND An estimated 1.1 million children and adolescents aged under 20 years have type 1 diabetes worldwide. Principal investigators from seven well-established longitudinal pediatric diabetes registries and the SWEET initiative have come together to provide an international collaborative perspective and comparison of the registries. WORK FLOW Information and data including registry characteristics, pediatric participant clinical characteristics, data availability and data completeness from the Australasian Diabetes Data Network (ADDN), Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids), Diabetes prospective follow-up registry (DPV), Norwegian Childhood Diabetes Registry (NCDR), National Paediatric Diabetes Audit (NPDA), Swedish Childhood Diabetes Registry (Swediabkids), T1D Exchange Quality Improvement Collaborative (T1DX-QI), and the SWEET initiative was extracted up until 31 December 2020. REGISTRY OBJECTIVES AND OUTCOMES The seven diabetes registries and the SWEET initiative collectively show data of more than 900 centers and around 100,000 pediatric patients, the majority with type 1 diabetes. All share the common objectives of monitoring treatment and longitudinal outcomes, promoting quality improvement and equality in diabetes care and enabling clinical research. All generate regular benchmark reports. Main differences were observed in the definition of the pediatric population, the inclusion of adults, documentation of CGM metrics and collection of raw data files as well as linkage to other data sources. The open benchmarking and access to regularly updated data may prove to be the most important contribution from registries. This study describes aspects of the registries to enable future collaborations and to encourage the development of new registries where they do not exist.
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Affiliation(s)
- Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | | | - Ajenthen G Ranjan
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Osman Gani
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Karin Akesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Shideh Majidi
- University of Colorado, Barbara Davis Center, Aurora, Colorado, USA
| | - Michael Witsch
- Department of Pediatrics DECCP, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Sabine Hofer
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Kasper A Pilgaard
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Siv Janne Kummernes
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Holly Robinson
- Royal College of Paediatrics and Child Health, London, UK
| | - Katarina Eeg-Olofsson
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA.,University of Mississippi School of Population Health, Jackson, Mississippi, USA
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Jannet Svensson
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torild Skrivarhaug
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Maria E Craig
- Charles Perkins Centre Westmead, University of Sydney, Australia.,The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of NSW, Sydney, New South Wales, Australia
| | - David Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford, California, USA
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Besser REJ, Ng SM, Gregory JW, Dayan CM, Randell T, Barrett T. General population screening for childhood type 1 diabetes: is it time for a UK strategy? Arch Dis Child 2022; 107:790-795. [PMID: 34740879 DOI: 10.1136/archdischild-2021-321864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/18/2021] [Indexed: 12/21/2022]
Abstract
Type 1 diabetes (T1D) is a chronic autoimmune disease of childhood affecting 1:500 children aged under 15 years, with around 25% presenting with life-threatening diabetic ketoacidosis (DKA). While first-degree relatives have the highest risk of T1D, more than 85% of children who develop T1D do not have a family history. Despite public health awareness campaigns, DKA rates have not fallen over the last decade. T1D has a long prodrome, and it is now possible to identify children who go on to develop T1D with a high degree of certainty. The reasons for identifying children presymptomatically include prevention of DKA and related morbidities and mortality, reducing the need for hospitalisation, time to provide emotional support and education to ensure a smooth transition to insulin treatment, and opportunities for new treatments to prevent or delay progression. Research studies of population-based screening strategies include using islet autoantibodies alone or in combination with genetic risk factors, both of which can be measured from a capillary sample. If found during screening, the presence of two or more islet autoantibodies has a high positive predictive value for future T1D in childhood (under 18 years), offering an opportunity for DKA prevention. However, a single time-point test will not identify all children who go on to develop T1D, and so combining with genetic risk factors for T1D may be an alternative approach. Here we discuss the pros and cons of T1D screening in the UK, the different strategies available, the knowledge gaps and why a T1D screening strategy is needed.
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Affiliation(s)
- Rachel Elizabeth Jane Besser
- Department of Paediatric Diabetes and Endocrinology, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK .,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - John W Gregory
- Division of Population Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Colin M Dayan
- Clinical Diabetes and Metabolism, Cardiff University School of Medicine, Cardiff, UK
| | | | - Timothy Barrett
- Diabetes Unit, Institute of Child Health, Birmingham Women's and Children's Hospital, Birmingham, UK
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38
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Bali IA, Al-Jelaify MR, AlRuthia Y, Mulla JZ, Amlih DF, Bin Omair AI, Al Khalifah RA. Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children. JAMA Netw Open 2022; 5:e2230043. [PMID: 36066894 PMCID: PMC9449786 DOI: 10.1001/jamanetworkopen.2022.30043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Intravenous (IV) insulin infusion is the standard of care for treating diabetic ketoacidosis (DKA) worldwide. Subcutaneous (SC) insulin aspart could decrease the use of health care resources. OBJECTIVE To compare the cost-effectiveness of mild uncomplicated DKA management with SC insulin aspart vs IV insulin infusion among pediatric patients from the perspective of a public health care payer using clinical data. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation included children aged 2 to 14 years presenting to the emergency department of a single academic medical center with mild DKA between January 1, 2015, and March 15, 2020. The medical records for DKA treatment course and its associated hospitalization costs were reviewed. Data were analyzed from January 1, 2015, to March 15, 2020. EXPOSURES Subcutaneous insulin aspart vs IV regular insulin infusion. MAIN OUTCOMES AND MEASURES The incremental cost-effectiveness ratio (US dollars per hour), duration of DKA treatment, and length of hospital stay. RESULTS A total of 129 children with mild DKA episodes (mean [SD] age, 9.9 [3.1] years; 72 girls [55.8%]) were enrolled in the study. Seventy children received SC insulin aspart and 59 received IV regular insulin. Overall, the length of hospital stay in the SC insulin group was reduced (mean, 16.9 [95% CI, -31.0 to -2.9] hours) compared with the IV insulin group (P = .005). The mean (SD) cost of hospitalization in the SC insulin group (US $1071.99 [US $523.89]) was less than that in the IV insulin group (US $1648.90 [US $788.03]; P = .001). The incremental cost-effectiveness ratio was -34.08 (95% CI, -25.97 to -129.82) USD/h. The use of SC insulin aspart was associated with a lower likelihood of prolonged hospital stay (β = -17.22 [95% CI, -32.41 to -2.04]; P = .03) than IV regular insulin when controlling for age and sex. CONCLUSION AND RELEVANCE Findings of this economic evaluation suggest that SC insulin aspart is dominant vs IV regular insulin in the management of mild uncomplicated DKA in children.
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Affiliation(s)
- Ibrahim Abdulaziz Bali
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jaazeel Zohair Mulla
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Dana Fawzi Amlih
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Reem Abdullah Al Khalifah
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Auzanneau M, Rosenbauer J, Warncke K, Maier W, Kamrath C, Hofmann T, Wurm M, Hammersen J, Schröder C, Hake K, Holl RW. Frequency of Ketoacidosis at Diagnosis of Pediatric Type 1 Diabetes Associated With Socioeconomic Deprivation and Urbanization: Results From the German Multicenter DPV Registry. Diabetes Care 2022; 45:1807-1813. [PMID: 35727029 DOI: 10.2337/dc21-2227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether socioeconomic deprivation and urbanization are associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of pediatric type 1 diabetes. RESEARCH DESIGN AND METHODS Children and adolescents aged ≤18 years, living in Germany, with newly diagnosed type 1 diabetes documented between 2016 and 2019 in the Diabetes Prospective Follow-up Registry (DPV; Diabetes-Patienten-Verlaufsdokumentation), were assigned to a quintile of regional socioeconomic deprivation (German Index of Socioeconomic Deprivation) and to a degree of urbanization (Eurostat) by using their residence postal code. With multiple logistic regression models, we investigated whether the frequency of DKA at diagnosis was associated with socioeconomic deprivation or urbanization and whether associations differed by age-group, sex, or migration status. RESULTS In 10,598 children and adolescents with newly diagnosed type 1 diabetes, the frequency of DKA was lowest in the least deprived regions (Q1: 20.6% [95% CI 19.0-22.4], and increased with growing socioeconomic deprivation to 26.9% [25.0-28.8] in the most deprived regions [Q5]; P for trend <0.001). In rural areas, the frequency of DKA at diagnosis was significantly higher than in towns and suburbs (intermediate areas) or in cities (27.6% [95% CI 26.0-29.3] vs. 22.7% [21.4-24.0], P < 0.001, or vs. 24.3% [22.9-25.7], P = 0.007, respectively). The results did not significantly differ by age-group, sex, or migration background or after additional adjustment for socioeconomic deprivation or urbanization. CONCLUSIONS This study provides evidence that prevention of DKA at diagnosis by means of awareness campaigns and screening for presymptomatic type 1 diabetes should particularly target socioeconomically disadvantaged regions and rural areas.
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Affiliation(s)
- Marie Auzanneau
- Zentralinstitut für Biomedizinische Technik (ZIBMT), Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Katharina Warncke
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, Munich, Germany
| | - Werner Maier
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Clemens Kamrath
- Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Thomas Hofmann
- Pediatric Practice of the Medical Center Arnsberg, Hochsauerland Clinic, Arnsberg, Germany
| | - Michael Wurm
- St. Hedwig Clinic for Pediatric and Adolescent Medicine, Regensburg University, Hospital of the Order of St. John of God, Regensburg, Germany
| | - Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Carmen Schröder
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Greifswald, Greifswald, Germany
| | - Kathrin Hake
- Children's Hospital, Müritzklinikum Waren, Waren, Germany
| | - Reinhard W Holl
- Zentralinstitut für Biomedizinische Technik (ZIBMT), Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Sharma S, Adhikari A, Adhikari S, Poudel S, Bk R, Mainali G, Yadav SK. Successful medical management of diabetic ketoacidosis at first presentation in a child with type 1 diabetes: A case report. Ann Med Surg (Lond) 2022; 79:103981. [PMID: 35860061 PMCID: PMC9289310 DOI: 10.1016/j.amsu.2022.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shriya Sharma
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
- Corresponding author.
| | | | | | - Sabin Poudel
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Reshu Bk
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Gaurab Mainali
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Clapin H, Smith G, Vijayanand S, Jones T, Davis E, Haynes A. Moderate and severe diabetic ketoacidosis at type 1 diabetes onset in children over two decades: A population-based study of prevalence and long-term glycemic outcomes. Pediatr Diabetes 2022; 23:473-479. [PMID: 35218122 DOI: 10.1111/pedi.13327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/13/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate in a population-based pediatric cohort: prevalence of moderate-severe diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) diagnosis over two decades and its association with long-term glycemic control. RESEARCH DESIGN AND METHODS Children <16 years diagnosed with T1D in Western Australia 2000-2019 were included and followed up for ≤14 years. Moderate-severe DKA at diagnosis was defined as serum pH < 7.2 or bicarbonate<10 mmol/L with hyperglycemia and ketosis. HbA1c was measured ~3-monthly. Trend in prevalence of moderate-severe DKA at diagnosis was investigated using a logistic regression model adjusting for sex, age, socioeconomic status, and area of residence. Long-term glycemic control associated with DKA at diagnosis was investigated using linear mixed models adjusting for the same variables and also for visit frequency, CGM and pump use. RESULTS Moderate-severe DKA occurred in 534 of 2111 (25.3%) participants. Odds of presenting with moderate-severe DKA increased by 4.1% (95% CI: 2.3, 5.9; p < 0.001) per year. Patients with moderate-severe DKA at diagnosis had higher HbA1c levels than other patients initially; the groups were similar between 2 and 6 years duration; from 7 years HbA1c levels tracked higher in the group with moderate-severe DKA at diagnosis with significant differences at 8 and 12 years (p < 0.05). CONCLUSION The increasing prevalence of DKA at diagnosis of pediatric T1D is concerning and highlights the need for early detection programs. Unlike a similar US study, this study did not find a consistent, clinically significant relationship between DKA at diagnosis and long-term HbA1c, raising important questions about the influence of other factors on long-term glycemic outcomes.
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Affiliation(s)
- Helen Clapin
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Grant Smith
- Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Sathyakala Vijayanand
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Timothy Jones
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Elizabeth Davis
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
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42
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Wolf RM, Noor N, Izquierdo R, Jett D, Rewers A, Majidi S, Sheanon N, Breidbart E, Demeterco‐Berggren C, Lee JM, Kamboj MK, Ebekozien O. Increase in newly diagnosed type 1 diabetes in youth during the COVID-19 pandemic in the United States: A multi-center analysis. Pediatr Diabetes 2022; 23:433-438. [PMID: 35218124 PMCID: PMC9115477 DOI: 10.1111/pedi.13328] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND An increase in newly diagnosed type 1 diabetes (T1D) has been posited during the COVID-19 pandemic, but data are conflicting. We aimed to determine trends in newly diagnosed T1D and severity of presentation at diagnosis for pediatric and adolescent patients during COVID-19 (2020) as compared to the previous year (2019) in a multi-center analysis across the United States. METHODS This retrospective study from seven centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) included data on new onset T1D diagnosis and proportion in DKA at diagnosis from January 1 to December 31, 2020, compared to the prior year. Chi-square tests were used to compare differences in patient characteristics during the pandemic period compared to the prior year. RESULTS Across seven sites, there were 1399 newly diagnosed T1D patients in 2020, compared to 1277 in 2019 (p = 0.007). A greater proportion of newly diagnosed patients presented in DKA in 2020 compared to 2019 (599/1399(42.8%) vs. 493/1277(38.6%), p = 0.02), with a higher proportion presenting with severe DKA (p = 0.01) as characterized by a pH <7.1 and/or bicarbonate of <5 mmol/L. Monthly data trends demonstrated a higher number of new T1D diagnoses over the spring and summer months (March to September) of 2020 compared to 2019 (p < 0.001). CONCLUSIONS We found an increase in newly diagnosed T1D and a greater proportion presenting in DKA at diagnosis during the COVID-19 pandemic compared to the prior year. Future longitudinal studies are needed to confirm these findings with population level data and determine the long-term impact of COVID-19 on diabetes trends.
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Affiliation(s)
- Risa M. Wolf
- Department of Pediatrics, Division of Pediatric EndocrinologyJohns Hopkins MedicineBaltimoreMarylandUSA
| | | | | | - Destiny Jett
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | | | | | - Nicole Sheanon
- Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | | | | | - Joyce M. Lee
- Mott Children's Hospital, Susan B. Meister Child Health Evaluation and Research CenterUniversity of MichiganAnn ArborMichiganUSA
| | | | - Osagie Ebekozien
- T1D ExchangeBostonMassachusettsUSA,University of Mississippi Medical CenterJacksonMississippiUSA
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43
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Maltoni G, Zioutas M, Mosticchio M, Iughetti L, Predieri B, Bruzzi P, Iovane B, Lazzeroni P, Graziani V, Suprani T, Monti S, Street ME, Lasagni A, De Luca F, Libertucci F, Mainetti B, Riboni S, Sogno Valin P, Pession A, Zucchini S. A comparative study on the incidence of type 1 diabetes mellitus between children of North African migrants and Italian children in Emilia-Romagna region, Italy. Eur J Pediatr 2022; 181:1523-1529. [PMID: 35028726 DOI: 10.1007/s00431-021-04340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED In the last few decades, many studies have reported an increasing global incidence of type 1 diabetes. Studies on migrant populations have underlined the importance of both environmental and genetic factors. AIMS Evaluate the incidence of type 1 diabetes in North African vs Italian children aged 0-14 years from 1 January 2015, to 31st December 2018, in Emilia-Romagna region, Italy. METHODS Clinical and epidemiological data about childhood onset type 1 diabetes in Emilia Romagna region were retrospectively collected by the regional centers of pediatric diabetology and matched using 3 different data sources. RESULTS 365 new cases were diagnosed. Total cumulative incidence was 15.4/100,000/year. North African cases showed a cumulative incidence of 53.8/100,000/year, statistically significant compared to cumulative incidence of the Italian cases alone 13.1/100,000/year (p value < 0.001). The annual incidence did not differ in the 4 years for both groups. Conclusion: The incidence of type 1 diabetes in the pediatric age (0 14 years) was significantly higher in the North African population than in the Italian one, suggesting that a mix of genetic and environmental factors may have caused the increase in newly diagnosed cases. WHAT IS KNOWN • The incidence of type 1 diabetes largely varies worldwide. • Study on immigrants helped to better understand the interplay role between genetics and environment. WHAT IS NEW • This is the first study focused on the incidence of children and adolescents of North African migrants in Italy. • The incidence of children and adolescents of North African migrants in Emilia Romagna region, Italy, seems to be higher than that reported in the host countries, and, above all, than that reported in highest-incidence countries in Europe and in the world.
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Affiliation(s)
- Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy.
| | - Maximiliano Zioutas
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy
| | - Marta Mosticchio
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and SurgicalSciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and SurgicalSciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Medical and SurgicalSciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Brunella Iovane
- Center for Diabetes in Children and Adolescents, Department of Woman and Child Health, Parma University Hospital, Parma, Italy
| | - Pietro Lazzeroni
- Center for Diabetes in Children and Adolescents, Department of Woman and Child Health, Parma University Hospital, Parma, Italy
| | - Vanna Graziani
- Department of Pediatrics, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Tosca Suprani
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Sara Monti
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Maria E Street
- Division of Pediatric Endocrinology and Diabetology Pediatrics, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Lasagni
- Division of Pediatric Endocrinology and Diabetology Pediatrics, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca De Luca
- Pediatrics Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124, Ferrara, Italy
| | | | | | - Sara Riboni
- Department of Pediatrics and Neonatology, Guglielmo da Saliceto Hospital, Cantone del Cristo 50, Piacenza, Italy
| | - Paola Sogno Valin
- Department of Pediatrics, Santa Maria Della Scaletta Hospital, Imola, Italy
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy
| | - Stefano Zucchini
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy
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44
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Affiliation(s)
- Mark A Sperling
- From the Department of Pediatrics, Division of Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York (M.A.S.); and the Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, and Harvard Medical School - both in Boston (L.M.L.)
| | - Lori M Laffel
- From the Department of Pediatrics, Division of Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York (M.A.S.); and the Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, and Harvard Medical School - both in Boston (L.M.L.)
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45
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Berot A, Gitton A, Diallo AM, Rahim A, Lukas C, Souchon PF, Salmon AS, François M, Ly S, Vitellius G, Decoudier B, Sulmont V, Delemer B, Barraud S. Characteristics of newly diagnosed type 1 diabetes in paediatric and adult population from Reims University Hospital, France from 1997 to 2019. DIABETES & METABOLISM 2022; 48:101346. [PMID: 35339663 DOI: 10.1016/j.diabet.2022.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
French health insurance data showed that the incidence of type 1 diabetes mellitus (T1DM) in children increased over the years to 2015. The objective of our study was to assess the evolution of the number of incident cases of paediatric and adult type 1 diabetes in our institution, and to describe their clinical presentation and its evolution. All patients with T1DM managed at diagnosis at Reims University Hospital between 1997 and 2019 were included. The clinical and biological data were extracted from the Champagne-Ardenne Diabetes Network database. Included were 847 patients with a median age of 10.3 years. Diagnosis was established in 71% of cases before 15 years, 7.4% after 35 years. The number of newly diagnosed cases was 3.6-times higher in 2019 compared to 1997. Ketoacidosis, the frequency of which decreased with age (P < 0.0001), revealed diabetes in a total of 32% of cases and in 46% of children under 5 years. It was more severe in children than in adults (P = 0.03), and its frequency increased over the study period. Hypotrophy was found in 23% of children under 15 years of age, and was more pronounced before 5 years of age, with no improvement over time. We saw an increase in the frequency of obesity or overweight among adults. Our study showed an increase in incident cases of diabetes in our hospital that continued over time for both children and adults. Clinical features at diagnosis deteriorated during this period for those under 15 years of age with an increase in ketoacidosis frequency.
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Affiliation(s)
- Aurélie Berot
- CHU de Reims - American Memorial Hospital - Service de Pédiatrie, 47 rue Cognac Jay, 51092 Reims Cedex, France; Laboratoire d'Education et Pratiques de Santé, EA 3412, Université Sorbonne Paris Nord, 74 rue Marcel Cachin, 93017 Bobigny, France
| | - Anne Gitton
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France
| | - Alpha Mamadou Diallo
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France; Laboratoire de recherche en Santé Publique, Vieillissement, Qualité de vie et Réadaptation des Sujets Fragiles, EA 3797, Université Reims Champagne-Ardenne, Reims, France
| | - Assia Rahim
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France
| | - Céline Lukas
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France
| | - Pierre François Souchon
- CHU de Reims - American Memorial Hospital - Service de Pédiatrie, 47 rue Cognac Jay, 51092 Reims Cedex, France
| | - Anne Sophie Salmon
- CHU de Reims - American Memorial Hospital - Service de Pédiatrie, 47 rue Cognac Jay, 51092 Reims Cedex, France
| | - Maud François
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France
| | - Sang Ly
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France
| | - Géraldine Vitellius
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France
| | - Bénédicte Decoudier
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France
| | - Véronique Sulmont
- CHU de Reims - American Memorial Hospital - Service de Pédiatrie, 47 rue Cognac Jay, 51092 Reims Cedex, France
| | - Brigitte Delemer
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France; CRESTIC EA 3804, Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687 Reims CEDEX 2, France
| | - Sara Barraud
- CHU de Reims - Hôpital Robert Debré, Service d'Endocrinologie - Diabète - Nutrition, Avenue du Général Koenig, 51092 Reims Cedex, France; CRESTIC EA 3804, Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687 Reims CEDEX 2, France.
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46
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d’Annunzio G, Bassi M, De Rose EL, Lezzi M, Minuto N, Calevo MG, Gaiero A, Fichera G, Borea R, Maghnie M. Increased Frequency of Diabetic Ketoacidosis: The Link With COVID-19 Pandemic. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:846827. [PMID: 36992744 PMCID: PMC10012091 DOI: 10.3389/fcdhc.2022.846827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 06/19/2023]
Abstract
AIMS Diabetic ketoacidosis is the most severe metabolic derangement due to prolonged insulin deficiency as in type 1 diabetes. Diabetic ketoacidosis, a life-threatening condition, is often diagnosed late. A timely diagnosis is mandatory to prevent its consequences, mainly neurological. The COVID-19 pandemic and lockdown have reduced the availability of medical care and access to hospitals. The aim of our retrospective study was to compare the frequency of ketoacidosis at the diagnosis of type 1 diabetes between the lockdown-post lockdown period and the previous two calendar years, in order to evaluate the impact of the COVID-19 pandemic. PATIENTS AND METHODS We retrospectively assessed the clinical and metabolic data at the diagnosis of type 1 diabetes in children in the Liguria Region during 3 different time periods: calendar year 2018 (Period A), calendar year 2019 until February 23,2020 (Period B) and from February 24, 2020 onwards to March 31, 2021 (Period C). RESULTS We analyzed 99 patients with newly-diagnosed T1DM from 01/01/2018 to 31/03/2021. Briefly, a younger age at diagnosis of T1DM was observed in Period 2 compared to Period 1 (p = 0.03). The frequency of DKA at clinical onset of T1DM was similar in Period A (32.3%) and Period B (37.5%), while it significantly increased in Period C (61.1%) compared to Period B (37.5%) (p = 0.03). PH values were similar in Period A (7.29 ± 0.14) and Period B (7.27 ± 0.17), while they were significantly lower in Period C (7.21 ± 0.17) compared to Period B (p = 0.04). CONCLUSIONS An increase in the frequency of diabetic ketoacidosis has been documented in newly diagnosed pediatric patients in the Liguria Region during and after the lockdown period compared to previous calendar years. This increase could have been caused by the delay in diagnosis following the restrictions imposed by the lockdown with consequently reduced access to health care facilities. More information on the risks of ketoacidosis is desirable by means of social and medical awareness campaigns.
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Affiliation(s)
- Giuseppe d’Annunzio
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bassi
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Elena Lucia De Rose
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Marilea Lezzi
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Alberto Gaiero
- Pediatric and Neonatology Unit, San Paolo Hospital, Savona, Italy
| | | | | | - Mohamad Maghnie
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
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47
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Mastromauro C, Blasetti A, Primavera M, Ceglie L, Mohn A, Chiarelli F, Giannini C. Peculiar characteristics of new-onset Type 1 Diabetes during COVID-19 pandemic. Ital J Pediatr 2022; 48:26. [PMID: 35139895 PMCID: PMC8827260 DOI: 10.1186/s13052-022-01223-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/22/2022] [Indexed: 01/30/2023] Open
Abstract
Background The COVID-19 pandemic period is having a strong impact on the management of diabetes as well as other chronic diseases as shown by the most severe clinical presentation at onset. The aim of this study was to evaluate the severity of diabetic ketoacidosis (DKA) in youth with newly diagnosed type 1 diabetes in “Santissima Annunziata Hospital” (Chieti, Italy) during COVID-19 pandemic in comparison to the five previous years. Methods A retrospective population-based incidence study was performed. Data were obtained from hospital records of 172 patients with new onset type 1 diabetes divided into two groups according to the diagnosis: Group I, between January 2015 and February 2020; Group II, between March 2020 and April 2021. Data regarding anthropometric, socio-economic and laboratory test were analyzed. DKA (pH < 7.30) and different severity of the disease (severe pH < 7.10; moderate pH < 7.20, mild pH < 7.30) were evaluated. A Spearman correlation between pH values and the main variables of interest was performed. Results DKA frequency was increased by 19 percentage in Group II compared to Group I (55% vs 36%; P = 0.03) with a significant increased risk of severe DKA cases compared to the previous five years (severe DKA 22.5% vs. 8.4%, P = 0.01). pH values were significantly related with HbA1c, blood glucose and c-peptide values in all groups. In addition, in Group II but not in Group I, pH values correlated with Triglycerides and TG/HDL cholesterol ratio. Conclusions During COVID-19 pandemic the risk of more severe clinical presentation of type 1 diabetes at onset is increased. The correlation with lipid profile might suppose an additional effect of lifestyle changes beside the delay in the diagnosis. Modifications of health care system need to be implemented during this peculiar situation in order to avoid such a relevant complication at onset.
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Affiliation(s)
- Concetta Mastromauro
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Annalisa Blasetti
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Marina Primavera
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Lucio Ceglie
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Angelika Mohn
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy. .,Department of Pediatrics, University of Chieti, Chieti, Italy.
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48
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Goldman S, Pinhas-Hamiel O, Weinberg A, Auerbach A, German A, Haim A, Zung A, Brener A, Strich D, Azoulay E, Levy-Khademi F, Ludar H, Koren I, Rachmiel M, Yackobovitch-Gavan M, Zuckerman-Levin N, David O, Halloun R, Cahn R, Ben-Ari T, Yeshayahu Y, Landau Z, Phillip M, Lebenthal Y. Alarming increase in ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the first wave of the COVID-19 pandemic in Israel. Pediatr Diabetes 2022; 23:10-18. [PMID: 34865288 DOI: 10.1111/pedi.13296] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/02/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the incidence and severity of ketoacidosis (DKA) at type 1 diabetes diagnosis during the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Israel. RESEARCH DESIGN AND METHODS A population-based study the product of a national collaboration of Israeli pediatric diabetes centers investigated the presentation of childhood-onset type 1 diabetes. The frequencies of DKA and severe DKA observed during the COVID-19 period from March 15, 2020 (commencement of the first nationwide lockdown) until June 30, 2020 were compared with the same periods in 2019, 2018, and 2017 using multivariable logistic regression, adjusting for age, sex, and socioeconomic position. RESULTS During the COVID-19 period, DKA incidence was 58.2%, significantly higher than in 2019 (adjusted OR [aOR] 2.18 [95% CI, 1.31-3.60], P = 0.003); 2018 (aOR 2.05 [95% CI, 1.26-3.34], P = 0.004); and 2017 (aOR, 1.79 [95% CI, 1.09-2.93], P = 0.022). The incidence of severe DKA was 19.9%, significantly higher than in 2018 (aOR, 2.49 [95% CI, 1.20-5.19], P = 0.015) and 2017 (aOR, 2.73 [95% CI, 1.28-5.82], P = 0.009). In 2020, admissions and duration of stay in the intensive care unit were higher than in previous years (P = 0.001). During the COVID-19 pandemic, children aged 6-11 years had higher incidences of DKA (61.3% vs. 34.0%, 40.6%, and 45.1%, respectively, P = 0.012), and severe DKA (29.3% vs. 15.1%, 10.9%, and 5.9%, respectively, P = 0.002). CONCLUSIONS The dramatic increase in DKA at presentation of childhood-onset type 1 diabetes during the COVID-19 pandemic mandates targeted measures to raise public and physician awareness.
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Affiliation(s)
- Shira Goldman
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Weinberg
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Adi Auerbach
- Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alina German
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alon Haim
- Pediatric Endocrinology and Metabolic Unit, Soroka University Medical Center, Beer Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amnon Zung
- The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Endocrinology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Avivit Brener
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Strich
- Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Specialist Clinic, Clalit Health Services, Jerusalem, Israel
| | - Erez Azoulay
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Floris Levy-Khademi
- Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hanna Ludar
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Endocrine Unit, Ha'Emek Medical Center, Afula, Israel
| | - Ilana Koren
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Endocrinology and Diabetes Unit, Carmel Medical Center, Clalit Health Services, Haifa, Israel
| | - Marianna Rachmiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nehama Zuckerman-Levin
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Diabetes Clinic, Diabetes, Endocrinology, and Metabolism Institute, Rambam Health Care Campus, Haifa, Israel
| | - Odeya David
- Pediatric Endocrinology and Metabolic Unit, Soroka University Medical Center, Beer Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Rana Halloun
- Pediatric Diabetes Clinic, Diabetes, Endocrinology, and Metabolism Institute, Rambam Health Care Campus, Haifa, Israel.,Pediatric Endocrinology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Ranit Cahn
- The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Ben-Ari
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology Unit, Edith Wolfson Medical Center, Holon, Israel
| | - Yonatan Yeshayahu
- Pediatric Endocrinology and Diabetes Unit, Assuta Ashdod Hospital, Ashdod, Israel.,Goldman School of Medicine, Ben-Gurion University, Beer-Sheva, Israel
| | - Zohar Landau
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatrics Department, Barzilai Medical Center, Ashkelon, Israel
| | - Moshe Phillip
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yael Lebenthal
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Lança A, Rodrigues C, Diamantino C, Fitas AL. COVID-19 in two children with new-onset diabetes: case reports. BMJ Case Rep 2022; 15:15/1/e247309. [PMID: 35042735 PMCID: PMC8768866 DOI: 10.1136/bcr-2021-247309] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Delayed diagnosis, low socioeconomic status and infection have been associated with diabetic ketoacidosis (DKA) at type 1 diabetes mellitus presentation. A teenager from a low socioeconomic status family, with longstanding weight loss, polyphagia, polyuria, vomiting and abdominal pain, attended the emergency department, also complaining of anosmia and odynophagia. He was diagnosed with COVID-19 and new-onset DKA. The second child had 2 weeks of diabetes symptoms and was admitted with new-onset mild DKA. SARS-CoV-2 RT-PCR test was positive, although asymptomatic. Persistent hyperglycaemia with high insulin requirements was a common feature to both patients. Both cases support that SARS-CoV-2 may have an association with rapidly increasing insulin daily needs. In case one, not only fear of COVID-19 delayed hospital attendance but also the setting of a low socioeconomic status family appears to have enhanced the risk for late diagnosis and challenging disease management.
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Affiliation(s)
- Ana Lança
- Pediatrics Department, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Cláudia Rodrigues
- Pediatrics Department, Hospital de Torres Novas, Centro Hospitalar do Médio Tejo EPE, Santarem, Portugal
| | - Catarina Diamantino
- Pediatrics Department, Endocrinology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Laura Fitas
- Pediatrics Department, Endocrinology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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50
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Nagl K, Waldhör T, Hofer SE, Fritsch M, Meraner D, Prchla C, Rami-Merhar B, Fröhlich-Reiterer E. Alarming Increase of Ketoacidosis Prevalence at Type 1 Diabetes-Onset in Austria-Results From a Nationwide Registry. Front Pediatr 2022; 10:820156. [PMID: 35237540 PMCID: PMC8882618 DOI: 10.3389/fped.2022.820156] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We analyzed the annual prevalence of onset-DKA (diabetic ketoacidosis) from 2012 to 2020 with a sub-analysis for lockdown-periods during the COVID-19 pandemic in 2020. DESIGN All newly diagnosed children with type 1 diabetes (T1D) aged <15 years are prospectively registered in the population-based Austrian Diabetes Incidence Study in Austria. MAIN OUTCOME MEASURES The annual DKA prevalence was analyzed using Joinpoint regression. Definition of DKA: pH <7.3, mild DKA: pH 7.3 to ≤ 7.1, severe DKA: pH <7.1. DKA prevalence during the lockdown periods in 2020 and the corresponding periods in 2015-2019 were examined using Fisher's exact test. RESULTS In the years 2012-2020 the mean prevalence for onset-DKA in Austria was 43.6% [95%CI (confidence interval): 41.6, 45.7] and thus above the mean prevalence of previous decades (1989-2011) of 37,1 % (95%CI: 35.6, 38.6). A particularly high prevalence was found among children <2 years of age (72.0% DKA, 32.8% severe DKA). No significant gender difference was found. Prevalence of severe DKA at T1D-onset increased significantly since 2015 (p = 0.023). During the lockdown in 2020, 59.3% of children were diagnosed with DKA at T1D-onset, compared to 42.1% during the previous 5 years (p = 0.022). Moreover, 20% of children had severe DKA at T1D diagnosis, compared to 14% during the comparison period. CONCLUSIONS The previously already high prevalence of DKA at T1D-onset has further increased over time. The COVID-19 pandemic has exacerbated the problem of a late or delayed diagnosis of diabetes in children resulting in onset-DKA. The alarmingly increased prevalence of DKA in Austrian children with T1D calls for urgent action.
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Affiliation(s)
- Katrin Nagl
- Department for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Waldhör
- Department for Epidemiology, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Sabine E Hofer
- Department for Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Dagmar Meraner
- Department for Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Birgit Rami-Merhar
- Department for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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