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

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt

  • Niels H. Birkebaek
  • Clemens Kamrath
  • Julia M. Grimsmann
  • Karin Aakesson
  • Valentino Cherubini
  • Klemen Dovc
  • Carine de Beaufort
  • Guy T. Alonso
  • John W. Gregory
  • Mary White
  • Torild Skrivarhaug
  • Zdenek Sumnik
  • Craig Jefferies
  • Thomas Hörtenhuber
  • Aveni Haynes
  • Martin De Bock
  • Justin T. Warner
  • Osman Gani
  • Rosaria Gesuita
  • Riccardo Schiaffini
  • Ragnar Hanas
  • Arleta Rewers
  • Alexander J. Eckert
  • Reinhard W. Holl
  • Ondrej Cinek

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.

OriginalsprogEngelsk
TidsskriftThe Lancet Diabetes and Endocrinology
Vol/bind10
Udgave nummer11
Sider (fra-til)786-794
Antal sider9
ISSN2213-8587
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
We thank Andreas Hungele and Ramona Ranz for their support and the development of the DPV documentation software (clinical data managers at the Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany). We also express our sincere thanks to Stefanie Lanzinger (Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany) for her statistical support in preparing the revision, and Joachim Rosenbauer (German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany) for his support in the segmented regression analysis. We thank all centres participating in the registries. We would like to commemorate the late Ann-Marie Svensson and thank for her long-term commitment to epidemiology of childhood type 1 diabetes and acknowledge her contribution to the planning phase of this Article and to the generation of hypotheses. The German, Austrian, and Luxemburg DPV registry is funded by the German Federal Ministry for Education and Research (BMBF) within the German Center for Diabetes Research (grant number 82DZD14E03), the German Robert Koch Institute (diabetes surveillance), the German Diabetes Association, and the German Diabetes Foundation (grant number FP-0446-2022). The Slovenian Childhood Diabetes Registry is supported by Slovenian Research Agency grants J3-6798, V3-1505, and P3-0343. The Children and Young People's Wales Diabetes Network (and Brecon Group) is funded by the Welsh Government. NHB is partially funded by The Health Research Foundation of the Central Denmark Region. SWEDIABKIDS is financially supported by the Swedish Association of Local Authorities and Regions.

Funding Information:
We thank Andreas Hungele and Ramona Ranz for their support and the development of the DPV documentation software (clinical data managers at the Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany). We also express our sincere thanks to Stefanie Lanzinger (Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany) for her statistical support in preparing the revision, and Joachim Rosenbauer (German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany) for his support in the segmented regression analysis. We thank all centres participating in the registries. We would like to commemorate the late Ann-Marie Svensson and thank for her long-term commitment to epidemiology of childhood type 1 diabetes and acknowledge her contribution to the planning phase of this Article and to the generation of hypotheses. The German, Austrian, and Luxemburg DPV registry is funded by the German Federal Ministry for Education and Research (BMBF) within the German Center for Diabetes Research (grant number 82DZD14E03), the German Robert Koch Institute (diabetes surveillance), the German Diabetes Association, and the German Diabetes Foundation (grant number FP-0446-2022). The Slovenian Childhood Diabetes Registry is supported by Slovenian Research Agency grants J3-6798, V3-1505, and P3-0343. The Children and Young People's Wales Diabetes Network (and Brecon Group) is funded by the Welsh Government. NHB is partially funded by The Health Research Foundation of the Central Denmark Region. SWEDIABKIDS is financially supported by the Swedish Association of Local Authorities and Regions. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps.

Publisher Copyright:
© 2022 Elsevier Ltd

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