medwireNews: Analysis of childhood type 1 diabetes diagnoses across 13 countries indicates that the conditions created by the COVID-19 pandemic worsened pre-existing increasing trends in ketoacidosis at diagnosis.
“The results of our study show that there is insufficient early diagnosis of type 1 diabetes in childhood worldwide,” write Niels Birkebaek (Steno Diabetes Center Aarhus, Denmark) and colleagues in The Lancet Diabetes & Endocrinology.
“Therefore, universal efforts are needed to reverse the increasing trend of diabetic ketoacidosis.”
The team’s study drew on registry data from 10 European countries, plus Australia, New Zealand, and the state of Colorado in the USA.
Among 87,228 children and adolescents diagnosed with type 1 diabetes between January 2006 and December 2019, 27.3% had diabetic ketoacidosis at diagnosis. Over this period, the prevalence of ketoacidosis at diagnosis increased by a significant estimated average of 1.6% annually, although the researchers note that the rising trend “was not steady throughout the study period.”
Only Italy had a decreasing prevalence of diabetic ketoacidosis over this period, of 1.1% per year. The largest annual increase, of 4.0%, occurred in Australia.
Based on these trends, the team calculated an expected prevalence of diabetic ketoacidosis at diagnosis of 32.5% and 33.0% for 2020 and 2021, respectively. However, the actual rates were 39.4% among 8209 children diagnosed in 2020 and 38.9% among 8853 diagnosed in 2021, giving absolute differences, adjusted for age and sex, of 6.9% and 5.8%, respectively between the observed and expected rates.
This pattern was true for most, but not all, individual countries. Of note, the researchers found a significant association between the stringency of lockdown measures and the likelihood of diabetic ketoacidosis.
Writing in a linked commentary, Shivani Misra (Imperial College London, UK) highlights this “novel finding,” which she says “suggests that the excess prevalence of diabetic ketoacidosis might be dissociated from direct SARS-CoV-2 infection.”
She says: “It is now well documented that the provision of routine health-care services across several countries was curtailed during the pandemic, with additional delays in people presenting to health-care providers due to a fear of contracting SARS-CoV-2.
“One could reasonably conclude that a primary factor explaining the excess prevalence of diabetic ketoacidosis during the pandemic might be related to these practical issues and this theory is certainly supported by the present analysis.”
But Misra notes the possible contribution of other factors, such as direct damage to the pancreas caused by SARS-CoV-2 and the potential for viral infection or increasing rates of obesity related to the lockdown triggering type 1 diabetes in susceptible children.
“For now, many questions relating to the rising prevalence of diabetic ketoacidosis during the pandemic remain unanswered and clarity will only emerge with time,” she concludes.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group
Lancet Diabetes Endocrinol 2022; doi:10.1016/S2213-8587(22)00246-7
Lancet Diabetes Endocrinol 2022; doi:10.1016/S2213-8587(22)00272-8