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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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Cherubini V, Marino M, Scaramuzza AE, Tiberi V, Bobbio A, Delvecchio M, Piccinno E, Ortolani F, Innaurato S, Felappi B, Gallo F, Ripoli C, Ricciardi MR, Pascarella F, Stamati FA, Citriniti F, Arnaldi C, Monti S, Graziani V, De Berardinis F, Giannini C, Chiarelli F, Zampolli M, De Marco R, Bracciolini GP, Grosso C, De Donno V, Piccini B, Toni S, Coccioli S, Cardinale G, Bassi M, Minuto N, D’Annunzio G, Maffeis C, Marigliano M, Zanfardino A, Iafusco D, Rollato AS, Piscopo A, Curto S, Lombardo F, Bombaci B, Sordelli S, Mameli C, Macedoni M, Rigamonti A, Bonfanti R, Frontino G, Predieri B, Bruzzi P, Mozzillo E, Rosanio F, Franzese A, Piredda G, Cardella F, Iovane B, Calcaterra V, Berioli MG, Lasagni A, Pampanini V, Patera PI, Schiaffini R, Rutigliano I, Meloni G, De Sanctis L, Tinti D, Trada M, Guerraggio LP, Franceschi R, Cauvin V, Tornese G, Franco F, Musolino G, Maltoni G, Talarico V, Iannilli A, Lenzi L, Matteoli MC, Pozzi E, Moretti C, Zucchini S, Rabbone I, Gesuita R. The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020. Front Endocrinol (Lausanne) 2022; 13:878634. [PMID: 35784550 PMCID: PMC9247264 DOI: 10.3389/fendo.2022.878634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/04/2022] [Indexed: 01/19/2023] Open
Abstract
AIM/HYPOTHESIS To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019. METHODS Forty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019. RESULTS Overall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p<0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p<0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively). CONCLUSIONS/INTERPRETATION There was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.
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Affiliation(s)
- Valentino Cherubini
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital” , Ancona, Italy
| | - Monica Marino
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital” , Ancona, Italy
- *Correspondence: Monica Marino,
| | - Andrea E. Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Pediatric Unit, ASST Cremona, Ospedale Maggiore, Cremona, Italy
| | - Valentina Tiberi
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital” , Ancona, Italy
| | | | - Maurizio Delvecchio
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Elvira Piccinno
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Federica Ortolani
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Stefania Innaurato
- Maternal and Child Health Department, Pediatric Unit - San Bortolo Hospital, Vicenza, Italy
| | - Barbara Felappi
- Pediatric Clinic, Children’s Hospital, ASST Spedali Civili Brescia, Brescia, Italy
| | | | - Carlo Ripoli
- Pediatric Diabetology Unit, Pediatric and Microcytemia Department, AO Brotzu, Cagliari, Italy
| | | | - Filomena Pascarella
- Pediatric Endocrinology Unit, Sant”Anna e San Sebastiano Hospital, Caserta, Italy
| | | | - Felice Citriniti
- Department of Pediatrics “Pugliese-Ciaccio” Hospital, Catanzaro, Italy
| | | | - Sara Monti
- Unit of Paediatrics, “ M.Bufalini” Hospital Cesena (FC), Unit of Paediatrics, “ S.M. Croci” Hospital Ravenna (RA), AUSL della Romagna Ravenna, Emilia-Romagna, Italy
| | - Vanna Graziani
- Unit of Paediatrics, “ M.Bufalini” Hospital Cesena (FC), Unit of Paediatrics, “ S.M. Croci” Hospital Ravenna (RA), AUSL della Romagna Ravenna, Emilia-Romagna, Italy
| | | | - Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | - Maria Zampolli
- Department of Pediatrics, ASST Lariana, Sant’Anna Hospital, Como, Italy
| | | | - Giulia Patrizia Bracciolini
- Pediatric and Pediatric Emergency unit, Children Hospital, ASO SS Antonio Biagio e Cesare Arrigo, Alessandria, Italy
| | - Caterina Grosso
- Pediatric and Pediatric Emergency unit, Children Hospital, ASO SS Antonio Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Barbara Piccini
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | - Sonia Toni
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | - Susanna Coccioli
- Unit of Pediatrics, “D. Camberlingo” Hospital, Francavilla Fontana, Brindisi, Italy
| | - Giuliana Cardinale
- Unit of Pediatrics, “Sacro Cuore di Gesù” Hospital Gallipoli (LE), Gallipoli, Italy
| | - Marta Bassi
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Nicola Minuto
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Giuseppe D’Annunzio
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Angela Zanfardino
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Assunta S. Rollato
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Alessia Piscopo
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Stefano Curto
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Bruno Bombaci
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | | | - Chiara Mameli
- Department of Pediatrics, V. Buzzi Children's Hospital. Univerisity of Milan, Milano, Lombardia, Italy
| | - Maddalena Macedoni
- Department of Pediatrics, V. Buzzi Children's Hospital. Univerisity of Milan, Milano, Lombardia, Italy
| | - Andrea Rigamonti
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giulio Frontino
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Bruzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Francesco Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Gavina Piredda
- Unit of Paediatrics, “Giovanni Paolo II“ Hospital, ASSL Olbia, Olbia, Italy
| | - Francesca Cardella
- Department of Pediatrics, Regional Center of Pediatric Diabetes, Children Hospital G. Di Cristina, Palermo, Italy
| | - Brunella Iovane
- Parma University Hospital Department of Mother and Child Pediatric, Parma, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia and “Vittore Buzzi” Chidren’s Hospital, Milano, Italy
| | - Maria Giulia Berioli
- Pediatric Diabetology Department, Azienda Ospedaliera di Perugia, Perugia, Umbria, Italy
| | - Anna Lasagni
- Pediatric Unit, Department of Obstetrics, Gynaecology and Paediatrics, Azienda AUSL-IRCCS Reggio Emilia, Italy
| | - Valentina Pampanini
- Pediatric Diabetology Department, Bambino Gesu Pediatric Hospital Roma, Lazio, Italy
| | | | - Riccardo Schiaffini
- Pediatric Diabetology Department, Bambino Gesu Pediatric Hospital Roma, Lazio, Italy
| | - Irene Rutigliano
- Casa Sollievo della Sofferenza” Research Institut, San Giovanni Rotondo, Puglia, Italy
| | - Gianfranco Meloni
- Department of Medical Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luisa De Sanctis
- Center of Pediatric Diabetology - A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Davide Tinti
- Center of Pediatric Diabetology - A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michela Trada
- Center of Pediatric Diabetology - A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Paola Guerraggio
- Centre of Paediatric Diabetology, Paediatric Unit, "Filippo Del Ponte" Children Hospital, ASST Sette Laghi, Varese, Italy
| | - Roberto Franceschi
- Department of Pediatrics, S.Chiara Hospital of Trento, Trento, Trentino-Alto Adige, Italy
| | - Vittoria Cauvin
- Department of Pediatrics, S.Chiara Hospital of Trento, Trento, Trentino-Alto Adige, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Francesca Franco
- Pediatric Department, ASUFC Hospital of Udine, Friuli-Venezia Giulia, Italy
| | - Gianluca Musolino
- Centre of Paediatric Diabetology, Paediatric Unit, “Filippo Del Ponte” Children Hospital, ASST Sette Laghi, Varese, Italy
| | - Giulio Maltoni
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Antonio Iannilli
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital” , Ancona, Italy
| | - Lorenzo Lenzi
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | | | - Erica Pozzi
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Carlo Moretti
- UOSD Pediatric Diabetology and Metabolism Unit, Children and Women Health Department, AOU Padova, Padova, Italy
| | - Stefano Zucchini
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic University of Marche, Ancona, Italy
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