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Tajdar D, Lühmann D, Walther L, Bittner L, Scherer M, Schäfer I. Effects of Two COVID-19 Lockdowns on HbA1c Levels in Patients with Type 1 Diabetes and Associations with Digital Treatment, Health Literacy, and Diabetes Self-Management: A Multicenter, Observational Cohort Study Over 3 Years. Diabetes Ther 2024; 15:1375-1388. [PMID: 38642263 PMCID: PMC11096287 DOI: 10.1007/s13300-024-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/22/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Short-term studies reported improved glycemic control and a decrease in eHbA1c (estimated hemoglobin A1c) in patients with type 1 diabetes during COVID-19 lockdown, but long-term changes are unknown. Therefore, the main objectives are to (1) analyze whether laboratory-measured HbA1c changed during and after two lockdowns and (2) investigate potential variables influencing HbA1c change. METHODS In this cohort study, 291 adults with type 1 diabetes were followed over 3 years including the prepandemic phase and two lockdowns. The data from medical records and validated questionnaires assessing health literacy (HLS-EU-Q16), diabetes self-management (DSMQ-R27), general self-efficacy (GSE), and social support (F-SOZU-K14) were used to analyze associations with HbA1c levels (N = 2370) by performing multivariable linear regressions. RESULTS The median age was 54 (38-63) years and 159 (54.6%) were male. All phases of the COVID-19 pandemic were associated with a significant increase in laboratory-measured HbA1c levels in percent (e.g., during first lockdown β = 0.23, 95% confidence interval (CI) 0.07-0.39, p = 0.005; during the second lockdown, β = 0.27, 95% CI 0.15-0.38, p < 0.001). HbA1c change during lockdowns was significantly affected by the number of checkups (β = -0.03, 95% CI -0.05 to -0.01, p = 0.010), the value of HbA1c at previous observation (β = 0.33, 95% CI 0.29-0.36, p < 0.001), educational level (secondary versus tertiary: β = 0.22, 95% CI 0.06-0.38, p = 0.008; primary versus tertiary: β = 0.31, 95% CI 0.10-0.52, p = 0.004), health literacy score (for each point: β = -0.03, 95% CI -0.05 to - 0.002, p = 0.034), and diabetes self-management score (for each point: β = -0.03, 95% CI -0.04 to -0.02, p < 0.001). The use of continuous glucose monitoring or insulin pump had no effect on HbA1c change. CONCLUSIONS Lockdowns can lead to worsening glycemic control in patients with type 1 diabetes. Particularly patients with few check-ups, poor blood glucose values, deficits in diabetes self-management, low health literacy, and a low level of education seem to be at greater risk of worsening glycemic control during lockdowns and, therefore, require special medical care, e.g., through telemedicine. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04821921.
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Affiliation(s)
- Daniel Tajdar
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dagmar Lühmann
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Laura Walther
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Lasse Bittner
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Scherer
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ingmar Schäfer
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Zeiler M, Wittek T, Graf T, Bozic I, Nitsch M, Waldherr K, Karwautz A, Wagner G, Berger G. Psychosocial impact of the COVID-19 pandemic for adolescents with type-1-diabetes: a qualitative interview study involving adolescents and parents. Behav Med 2023; 49:412-422. [PMID: 35816425 DOI: 10.1080/08964289.2022.2084358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 12/23/2022]
Abstract
This study aims to investigate the psychosocial impact of the COVID-19 pandemic on adolescents with type-1-diabetes (T1D). We conducted 18 semi-structured interviews including adolescents with T1D (n = 10, 50% female, 15-18 years) and their parents (n = 8, 88% mothers). The main topics addressed were experiences during confinement regarding everyday life, lifestyle behaviors, diabetes management and treatment. We applied thematic analysis to identify common patterns of meanings. Being aware of belonging to a potential COVID-19 risk group caused worries especially in parents which resulted in strict adherence to preventive measures. Information from trustworthy sources regarding the actual risk mitigated the concerns. Digital diabetes treatment was well accepted and experienced as highly usable. The pandemic situation either facilitated or hindered the transition from parental control to diabetes self-management. While some patients managed to improve healthy lifestyle behaviors as their everyday lives seemed more predictable, others had difficulties in adapting to changed daily routines resulting in increased sedentary behavior and snacking. The perceived level of stress was directly associated with blood glucose levels. In conclusion, the implementation of psychological interventions (both for adolescents with T1D and their parents) addressing mental health literacy and media literacy seems to be important to promote positive coping skills for dealing with the pandemic situation.
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Affiliation(s)
- Michael Zeiler
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Tanja Wittek
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Theres Graf
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Ina Bozic
- Diabetes Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna
| | - Martina Nitsch
- Ferdinand Porsche FernFH - Distance Learning University of Applied Sciences
| | - Karin Waldherr
- Ferdinand Porsche FernFH - Distance Learning University of Applied Sciences
| | - Andreas Karwautz
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Gudrun Wagner
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Gabriele Berger
- Diabetes Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna
- Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf
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Fotea S, Ghiciuc CM, Stefanescu G, Cianga AL, Mihai CM, Lupu A, Butnariu LI, Starcea IM, Salaru DL, Mocanu A, Chisnoiu T, Thet AA, Miron L, Lupu VV. Pediatric COVID-19 and Diabetes: An Investigation into the Intersection of Two Pandemics. Diagnostics (Basel) 2023; 13:2436. [PMID: 37510181 PMCID: PMC10378192 DOI: 10.3390/diagnostics13142436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a complex infectious disease caused by the SARS-CoV-2 virus, and it currently represents a worldwide public health emergency. The pediatric population is less prone to develop severe COVID-19 infection, but children presenting underlying medical conditions, such as diabetes mellitus, are thought to be at increased risk of developing more severe forms of COVID-19. Diabetic children face new challenges when infected with SARS-CoV-2. On one hand, the glycemic values become substantially more difficult to manage as COVID-19 is a predisposing factor for hyperglycemia. On the other hand, alongside other risk factors, high glycemic values are incriminated in modulating immune and inflammatory responses, leading to potentially severe COVID-19 cases in the pediatric population. Also, there are hypotheses of SARS-CoV-2 being diabetogenic itself, but this information is still to be confirmed. Furthermore, it is reported that there was a noticeable increase in the number of cases of new-onset type 2 diabetes among the pediatric population, and the complications in these patients with COVID-19 include the risk of developing autoimmune diseases under the influence of stress. Additionally, children with diabetes mellitus are confronted with lifestyle changes dictated by the pandemic, which can potentially lead to the onset or exacerbation of a potential underlying anxiety disorder or depression. Since the literature contains a series of unknowns related to the impact of COVID-19 in both types of diabetes in children, the purpose of our work is to bring together the data obtained so far and to identify potential knowledge gaps and areas for future investigation regarding COVID-19 and the onset of diabetes type 1 or type 2 among the pediatric population.
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Affiliation(s)
- Silvia Fotea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Department of Morpho-Functional Sciences II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Stefanescu
- I-st Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Lavinia Cianga
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Maria Mihai
- Pediatrics, Faculty of General Medicine, Ovidius University, 900470 Constanta, Romania
| | - Ancuta Lupu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iuliana Magdalena Starcea
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Delia Lidia Salaru
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adriana Mocanu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Tatiana Chisnoiu
- Pediatrics, Faculty of General Medicine, Ovidius University, 900470 Constanta, Romania
| | - Aye Aung Thet
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lucian Miron
- III-rd Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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O'Mahoney LL, Highton PJ, Kudlek L, Morgan J, Lynch R, Schofield E, Sreejith N, Kapur A, Otunla A, Kerneis S, James O, Rees K, Curtis F, Khunti K, Hartmann‐Boyce J. The impact of the COVID-19 pandemic on glycaemic control in people with diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2022; 24:1850-1860. [PMID: 35603919 PMCID: PMC9347483 DOI: 10.1111/dom.14771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022]
Abstract
AIM To identify, appraise and synthesize the available evidence on the impact of the coronavirus disease 2019 (COVID-19) pandemic and lockdown (LD) on glycaemic control in people with diabetes. MATERIALS AND METHODS We searched multiple databases up to 2 February 2021 for studies reporting HbA1c, time in range (TIR), average or fasting glucose, severe hypoglycaemia and diabetic ketoacidosis. Data were pooled using random effects meta-analysis and are presented as mean difference (MD) with 95% confidence intervals (CI). This review was preregistered on PROSPERO (CRD42020179319). RESULTS We include 59 studies; 44 (n = 15 464) were included in quantitative syntheses and 15 were narratively synthesized. Pooled data were grouped by diabetes type. Results from 28 studies (n = 5048 type 1 diabetes [T1D] and combined diabetes participants) showed that TIR increased during LD compared with before LD (MD 2.74%, 95% CI 1.80% to 3.69%). Data from 10 studies (n = 1294 T1D participants) showed that TIR increased after LD compared with before LD (MD 5.14%, 95% CI 3.12% to 7.16%). Pooled results from 12 studies (n = 4810 T1D and type 2 diabetes participants) resulted in average glucose decreasing after LD compared with before LD (MD -6.86 mg/dl, 95% CI -8.54 to -5.18). Results for other outcomes, including HbA1c, were not statistically significantly different. CONCLUSIONS The COVID-19 pandemic was associated with small improvements across multiple outcomes of glycaemic control, although there was insufficient evidence to suggest that this led to changes in HbA1c. Most evidence came from people with access to diabetes technologies in high-income countries; more research is needed in less advantaged populations.
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Affiliation(s)
| | | | - Laura Kudlek
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Rosie Lynch
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | | | | | - Ajay Kapur
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | | | - Sven Kerneis
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | - Olivia James
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | - Karen Rees
- Freelance Systematic ReviewerWarwickshireUK
| | - Ffion Curtis
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
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Denkboy Ongen Y, Eren E, Sahin KC, Buhur Pirimoglu M, Saglam H, Tarim O. Telemedicine experiences at a pediatric endocrinology clinic during the COVID-19 pandemic. Ir J Med Sci 2022; 191:985-990. [PMID: 34100191 PMCID: PMC8184055 DOI: 10.1007/s11845-021-02677-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/01/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The coronavirus 19 (COVID-19) pandemic has affected all aspects of life, including the routine follow-up of patients with chronic illnesses. In this study, we aim to share our experience of telemedicine in our pediatric endocrinology clinic during the pandemic. METHODS We were able to continue caring for children with endocrine disorders using various communication methods such as e-mail and e-message. RESULTS A total of 267 patients received telemedicine care over the course of 608 contacts. The number of hospital visits and physical contact was effectively reduced to help protect against the COVID-19 infection. The patients were supported in terms of receiving their prescriptions and patient education also continued. No complications were observed. CONCLUSION The advantages and disadvantages of telemedicine were discussed and consequently, we propose that telemedicine can be utilized to maintain and continue the care of children with endocrine disorders during and even after the pandemic. Further studies are needed to standardize this method for general use.
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Affiliation(s)
| | - Erdal Eren
- Bursa Uludag University, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Kadriye Cansu Sahin
- Bursa Uludag University, Department of Pediatric Endocrinology, Bursa, Turkey
| | | | - Halil Saglam
- Bursa Uludag University, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Omer Tarim
- Bursa Uludag University, Department of Pediatric Endocrinology, Bursa, Turkey
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Grudziąż-Sękowska J, Sękowski K, Kobuszewski B. Healthcare Utilization and Adherence to Treatment Recommendations among Children with Type 1 Diabetes in Poland during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084798. [PMID: 35457665 PMCID: PMC9031476 DOI: 10.3390/ijerph19084798] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 02/06/2023]
Abstract
Type 1 diabetes mellitus (T1D) is, next to obesity and asthma, the most common chronic disease in children in Poland. The results of T1D treatment strongly depend on the patient’s compliance with therapeutic recommendations, which entails the use of necessary health services. Based on a retrospective analysis of the data on health services provided in 2016–2020 to over 15.5 thousand patients with T1D in Poland, we assessed the compliance of the actual model of treatment of T1D in children with the current guidelines. It was found that only about 50% of patients received the number of diabetes consultations corresponding to the recognized standards, with about 15% of children with T1D remaining outside the public healthcare system. In the case of many outpatient services (ophthalmological, neurological, mental health), the number of consultations was extremely low—one order of magnitude lower than in general population and dropped even lower in 2020. This shows that the health needs of children with T1D are not being met within the public healthcare system. The COVID-19 pandemic caused significant limitations in access to healthcare in Poland. Compared to the pre-pandemic period there was a significant decrease (−27% compared to 2019) in the number of hospitalizations, and a substantial increase (+22% compared to 2019) in the number of diabetic ketoacidoses (DKA) cases. The proportion of hospitalizations caused by DKA rose to 8.9% compared to 7.3% in 2019.
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Affiliation(s)
- Justyna Grudziąż-Sękowska
- Centre of Postgraduate Medical Education, School of Public Health, 01-813 Warsaw, Poland;
- Correspondence: ; Tel.: +48-225-601-150
| | - Kuba Sękowski
- Doctoral School, Law College, Kozmiński University, 03-301 Warsaw, Poland;
| | - Bartosz Kobuszewski
- Centre of Postgraduate Medical Education, School of Public Health, 01-813 Warsaw, Poland;
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Rusak E, Seget S, Macherski M, Furgał N, Dyś P, Jarosz-Chobot P. Has the COVID-19 Pandemic Affected the Prevalence of Diabetic Ketoacidosis in Polish Children with Newly Diagnosed Type 1 Diabetes? An Example of the Largest Polish Pediatric Diabetes Center (Upper Silesia—Katowice, Poland). Healthcare (Basel) 2022; 10:healthcare10020348. [PMID: 35206962 PMCID: PMC8872196 DOI: 10.3390/healthcare10020348] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 01/25/2023] Open
Abstract
Purpose: The aim of this study was to analyze the prevalence of diabetic ketoacidosis (DKA) in children with newly disclosed type 1 diabetes (T1D) during the COVID-19 pandemic in 2020 compared to 2019. Methods: A retrospective analysis of the history database of all hospitalized children in our department. The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines were used for the diagnosis of DKA. Results: The database of children with newly disclosed T1D included 196 patients (89 girls and 107 boys) from 2019, and 223 patients (113 girls and 110 boys) from 2020 (a total of 419 patients—202 girls and 217 boys) aged 0 to 18 years. A significantly higher percentage of DKA was observed in 2020 compared to the previous year (47.53% vs. 35.2% [p = 0.005]). The percentage of severe DKA increased in 2020 compared to 2019 (18.39% vs. 14.07% [p = 0.118]). Compared to 2019, the average HbA1c level was higher in 2020 (12.57 ± 2.75% vs. 11.95 ± 2.89% [p < 0.025]), and the average pH level (7.26 vs. 7.31 [p = 0.002], and average HCO3 level (16.40 vs. 18.66 [p = 0.001]) were lower, respectively. Conclusions: During the COVID-19 (2020) pandemic, the incidence of DKA increased in Polish children with newly diagnosed T1D. The conclusions from the analysis of the functioning of health systems during the pandemic should be used in the future to prevent, in similar periods, an increase in severe complications of delayed diagnosis of T1D.
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Affiliation(s)
- Ewa Rusak
- Correspondence: ; Tel.: +48-32-207-1654
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Kofoed P, Timm S. The impact of COVID-19 lockdown on glycaemic control and use of health services among children followed at a Danish diabetes clinic. Acta Paediatr 2022; 111:368-375. [PMID: 34586678 PMCID: PMC8653272 DOI: 10.1111/apa.16128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022]
Abstract
Aim During COVID‐19 restrictions, the paediatric clinic only accepted essential outpatient visits, schools closed, sports activities and social life were limited. Most employees worked at home. This quasi‐experiment evaluates how this affected glycaemic control and use of health services among children with diabetes. Methods Paired t‐tests were used to compare HbA1c‐values before, during and after lockdown. Sub‐analyses were stratified by pre‐lockdown HbA1c‐values. Results Overall mean HbA1c decreased from 58.3 to 56.9 mmol/mol (p = 0.025) from pre‐ to post‐lockdown, a decrease also seen during the same season the previous year. HbA1c decreased by −4.2 mmol/mol (p = 0.002) for patients with pre‐lockdown HbA1c > 59 mmol/mol, but increased slightly by 0.8 mmol/mol (p = 0.176) for patients with HbA1c < 52 mmol/mol. HbA1c measured 8 months post‐lockdown increased again, most pronounced for patients with lowest HbA1c. During lockdown, virtual contacts increased from 0.1 to 0.5 contacts/patient/month and stayed post‐lockdown at 0.3 contacts/patient/month. Conclusion Compared to 2019, overall the COVID‐19 restrictions did not influence the glycaemic control negatively. However, patients with pre‐lockdown HbA1c < 52 mmol/mol experienced a deterioration, whereas those with HbA1c > 59 mmol/mol experienced an improvement. Less stress and more contact with parents may contribute to the last‐mentioned finding. The lockdown enforced more virtual contacts between patients and the clinic.
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Affiliation(s)
- Poul‐Erik Kofoed
- Department of Paediatrics and Adolescent Medicine Lillebaelt HospitalUniversity Hospital of Southern Denmark Kolding Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Signe Timm
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Research unit Lillebaelt HospitalUniversity Hospital of Southern Denmark Kolding Denmark
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Abdou M, Hassan MM, Hassanein SA, Elsebaie EH, Shamma RA. Presentations, Complications, and Challenges Encountered During Management of Type 1 Diabetes in Egyptian Children During COVID-19 Pandemic: A Single-Center Experience. Front Endocrinol (Lausanne) 2022; 13:814991. [PMID: 35360079 PMCID: PMC8963467 DOI: 10.3389/fendo.2022.814991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant challenges pertaining to the management of children and adolescents with type 1 diabetes (T1D). Issues such as fear of infection and lockdown measures have resulted in delayed and more severe clinical presentations of this disease. OBJECTIVES This study aimed at reporting the frequency and severity of diabetic ketoacidosis (DKA) and the rate of DKA complications in children with diabetes who presented to the emergency unit during COVID-19 pandemic. Furthermore, the purpose of this study was to compare the data collected from the first and second COVID-19 waves with that of the pre-COVID-19 period and describe the challenges encountered during disease management. METHODS This cross-sectional study included all children and adolescents with T1D who presented to the emergency department at Abo El Rish Children's Hospital, Cairo University, during the first and second COVID-19 waves. It also included data collected from the pre-COVID-19 period. Demographic and clinical data, investigations, and management details were collected from the patients' medical records. RESULTS Three hundred twenty-four Egyptian children and adolescents diagnosed with T1D were recruited. One hundred forty patients (43.2%) presented with severe DKA, and approximately 66% were newly diagnosed with T1D. The participants presented with manifestations suggestive of COVID-19, such as fever (29.5%), respiratory manifestations (7.2%), and gastrointestinal symptoms (14.7%). Thirty-seven patients were tested for severe acute respiratory syndrome coronavirus 2 infection using nasopharyngeal swabs, and four patients tested positive. Around 18% of patients developed hypokalemia during disease management. A comparison between these data and the data from previous years revealed that there was a significant increase in the number of newly diagnosed cases with more severe DKA at presentation and a higher frequency of development of hypokalemia during both COVID-19 waves. CONCLUSION An increase in the frequency of newly diagnosed cases was identified during the first and the second COVID-19 waves compared with the pre-COVID-19 period. The patients presented with more severe DKA, probably due to a more delayed presentation. The frequency of hypokalemia development was also significantly higher, and the severity of DKA was associated with a longer ICU admission. Further studies are required to establish a definitive link between the COVID-19 pandemic and the severity of presentation.
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Affiliation(s)
- Marise Abdou
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
- *Correspondence: Marise Abdou,
| | - Mona M. Hassan
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
| | - Samah A. Hassanein
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
| | - Eman H. Elsebaie
- Public Health and Community Medicine Department, Cairo University, Cairo, Egypt
| | - Radwa A. Shamma
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
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Hasan Tehrani T, Razavi Z, Salimi S, Farahi H, Bazmamoun H, Soltanian AR. Impact of Coronavirus Disease 2019 Outbreak on Children and Adolescents with Type 1 Diabetes Mellitus. J Res Health Sci 2021; 21:e00534. [PMID: 36511230 PMCID: PMC8957663 DOI: 10.34172/jrhs.2021.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aimed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on daily routines and health of patients with type 1 diabetes mellitus (T1DM). STUDY DESIGN A cross-sectional study. METHODS This study included 98 children and adolescents with type 1 diabetes who were regularly followed up in the Endocrinology outpatient clinic of Besat Hospital, Hamadan, Iran, in 2020. The primary measurements included body mass index, glycemic control, number of hypoglycemic events, number of hospitalizations, as well as bedtime and availability of insulin six months pre and post COVID-19 outbreak. The obtained data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically significant. RESULTS Out of 98 participants (mean±SD age: 13.5±49), 51% of the cases were male, and %81.6 of the patients were urban residents. Furthermore, most participants (43.9%) were in the age group of 11-15 years, and the mean±SD duration of diabetes was 4.64±3.31 years. In addition, 2.04% of the participants developed COVID-19. There was a statistically significant difference among average duration of night sleep (P<0.001), bedtime (P<0.001), time of waking up (P<0.001), amount of insulin intake (P=0.003), daily exercise (P<0.001), and availability of the insulin (P<0.001) before and during COVID-19 crisis. The frequencies of hospitalizations and hypoglycemic events were lower after the COVID-19 outbreak (P=0.005 and P=0.034, respectively). Morning insulin dose was omitted in 22.2% of participants. No differences were found between hemoglobin A1c and daytime sleep pre and post COVID-19 outbreak. CONCLUSIONS The key challenges due to COVID-19 pandemic restrictions for Iranian T1DM patients were the need to take more insulin, lower physical activity, non-availability of insulin, and missed morning insulin dose. However, it is worth mentioning that the patients' blood glucose control did not worsen in this period.
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Affiliation(s)
- Tayebeh Hasan Tehrani
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Razavi
- Department of Pediatrics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
,Correspondence: Zahra Razavi (MD) Tel: +98 918 3122066 E-mail:
| | - Samin Salimi
- Islamic Azad University, Tabriz Branch, Tabriz, Iran
| | - Hamidreza Farahi
- Department of Pediatrics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hasan Bazmamoun
- Department of Pediatrics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
,Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Umano GR, Di Sessa A, Guarino S, Gaudino G, Marzuillo P, Miraglia del Giudice E. Telemedicine in the COVID-19 era: Taking care of children with obesity and diabetes mellitus. World J Diabetes 2021; 12:651-657. [PMID: 33995852 PMCID: PMC8107973 DOI: 10.4239/wjd.v12.i5.651] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/01/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 infection was declared a pandemic in January 2020. Since then, several measures to limit virus transmission have been imposed; among them, home confinement has been the most severe, with drastic changes in the daily routines of the general population. The “stay at home” rule has impaired healthcare service access, and patients with chronic conditions were the most exposed to the negative effects of this limitation. There is strong evidence of the worsening of obesity and diabetes mellitus in children during this period. To overcome these issues, healthcare providers have changed their clinical practice to ensure follow-up visits and medical consultation though the use of telemedicine. Telemedicine, including telephone calls, videocalls, data platforms of shared telemedicine data platforms mitigated the negative effect of pandemic restrictions. Published evidence has documented good metabolic control and weight management outcomes in centers that performed extensive telemedicine services last year during the pandemic. This review discusses studies that investigated the use of telemedicine tools for the management of pediatric obesity and diabetes.
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Affiliation(s)
- Giuseppina Rosaria Umano
- Department of Woman, Child, and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Anna Di Sessa
- Department of Woman, Child, and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Stefano Guarino
- Department of Woman, Child, and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Giuseppina Gaudino
- Department of Woman, Child, and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child, and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Emanuele Miraglia del Giudice
- Department of Woman, Child, and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
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Affiliation(s)
- Johnny Ludvigsson
- Crown Princess Victoria Children´s Hospital and Div of Pediatrics Dept of Biomedical and Clinical Sciences Linköping University Linköping Sweden
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