Childhood Diabetes, DKA Rates Increase Early in COVID-19 Pandemic

The incidence in children and adolescents is Type 1 diabetes (T1D) Diabetic ketoacidosis (DKA) has increased significantly since the start of the COVID-19 pandemic, according to a review published today. JAMA network open.¹

Specifically, the incidence of T1D was 1.14-fold higher in the first year of the COVID-19 pandemic and 1.27-fold higher in the second year compared to the pre-pandemic 12 months.

This review included data from 42 studies, including 102,984 diabetes-onset cases. The included studies reported differences in diabetes onset in individuals younger than 19 years during the pandemic and with a minimum observation period of 12 months pre-pandemic.

The meta-analysis focused on the incidence of T1D and included 17 studies involving 38,149 adolescents. The results revealed that the first year of the pandemic had a higher incidence of T1D compared with the previous year (incidence ratio) [IRR], 1.14; 95% CI, 1.08–1.21). Diabetes incidence generally continued to rise during the 13-24 months of the pandemic (IRR, 1.27; 95% CI, 1.18-1.37).

Of the 42 studies, 10 reported incidents of type 2 diabetes (T2D) before and during the pandemic, but we were unable to pool the results because incidence rates were not provided. In addition, 15 studies reported the incidence of DKA, which was found to be 1.26 times higher during the COVID-19 pandemic compared to pre-pandemic (IRR, 1.26, 95% CI, 1.17-1.36).

According to the review authors, these findings were Meta-analysis for July 2022 To assess the incidence of T1D and DKA in children in 2019 and 2020.²

Potential explanations for the link between new-onset diabetes and previous SARS-CoV-2 infection include several proposed direct mechanisms, the authors said. These include the presence of ACE2, the receptor for SARS-CoV-2, on insulin-producing β-cells, potentially making them more susceptible to viral entry. Moreover, SARS-CoV-2 infection has been found to contribute to the disruption of glucose metabolism, further exacerbating the risk of diabetes. Individuals already predisposed to diabetes may be particularly susceptible to developing diabetes after SARS-CoV-2 infection due to a combination of dysregulation of glucose metabolism and direct damage to β-cells, thereby compensating for diabetes. capacity may be impaired, leading to β-cell depletion. .

However, despite these hypotheses, the precise underlying mechanisms that explain the association between SARS-CoV-2 infection and subsequent increased risk of developing diabetes remain unclear, the authors say.

They also noted limited data on changes in T2D incidence during the COVID-19 pandemic.

“The studies included in this systematic review and meta-analysis described an increase in the incidence of type 2 diabetes over time, but evaluated whether the incidence of childhood type 2 diabetes increased after the onset of type 2 diabetes. Insufficient data were reported to determine whether this is the beginning of a pandemic,” the authors said. “There are population-based studies that can measure the size (denominator) of the study population and thereby determine whether there has been a change in the incidence of type 2 diabetes in children and adolescents since the onset of the COVID-19 pandemic. It is needed.”

The results of this study highlight the importance of allocating resources to meet the immediate increased demand for pediatric diabetes care, which is likely to extend into young adulthood. It also highlights the importance of implementing strategies aimed at preventing DKA in her recently diagnosed diabetic patient.

“Although prospective data are needed to examine whether this trend continues, our findings suggest that potential direct and indirect mechanisms to explain this increase need to be elucidated. does,” the authors concluded. “Furthermore, data on socioeconomic, racial and ethnic disparities in diabetes incidence during the COVID-19 pandemic are lacking. must be filled in.”

References

1. D’Souza D, Empringham J, Pechlivanoglou P, Uleryk EM, Cohen E, Shulman R. Diabetes incidence in children and adolescents during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA net open. Published online on June 30, 2023. doi:10.1001/jamanetworkopen.2023.21281

2. Rahmati M, Keshvari M, Mirnasuri S, et al. Global impact of the COVID-19 pandemic on the incidence of new-onset type 1 diabetes and ketoacidosis in children: a systematic review and meta-analysis. J. Med Virol. 2022;94(11):5112-5127. doi:10.1002/jmv.27996