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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.

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. 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. Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel. The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel. Pediatric Department, Bnai Zion Medical Center, Haifa, Israel. The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 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. Pediatric Endocrinology Unit, Kaplan Medical Center, Rehovot, Israel. Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Pediatric Specialist Clinic, Clalit Health Services, Jerusalem, Israel. Pediatric Endocrine Unit, Ha'Emek Medical Center, Afula, Israel. Pediatric Endocrinology and Diabetes Unit, Carmel Medical Center, Clalit Health Services, Haifa, Israel. Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 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. Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel. Pediatric Endocrinology Unit, Edith Wolfson Medical Center, Holon, Israel. Pediatric Endocrinology and Diabetes Unit, Assuta Ashdod Hospital, Ashdod, Israel. Goldman School of Medicine, Ben-Gurion University, Beer-Sheva, Israel. Pediatrics Department, Barzilai Medical Center, Ashkelon, Israel.

Pediatric diabetes. 2022;(1):10-18
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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.

Methodological quality

Publication Type : Multicenter Study ; Observational Study

Metadata

MeSH terms : COVID-19