Effect of COVID-19 pandemic on presentation and referral patterns of newly diagnosed children with type 1 diabetes in a developing country
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Abstract
Objectives
The global spread of coronavirus disease 2019 (COVID-19), had a great impact on patients worldwide, including those with chronic diseases. We aim to study the effect of COVID-19 pandemic on presentation patterns of patients with type 1 diabetes (T1D) in Jordan, as an example a developing country with limited resources.
Methods
Medical charts were reviewed for patients presented with new-onset T1D to Jordan University hospital during the first year of pandemic and the preceding year. Categorical data were compared using Pearson Chi-Square and Fisher’s exact test. Continuous data were compared using the Independent Sample t-Test.
Results
A total of 137 children were diagnosed with T1D during the study period, with 60.6% of those children were diagnosed in the pre-pandemic year compared to 39.4% during the first year of pandemic, p-value=0.013. Percentage of patients diagnosed with DKA as first presentation of T1D during the pre-pandemic year was 34.9% compared to 51.9% during the pandemic year, p-value=0.049. Significant differences in family monthly income (p-value=0.006) and paternal education level (p-value=0.036) were found between children with DKA and those without DKA in the pre-pandemic year, but they were not significant during the pandemic year.
Conclusions
The unprecedented COVID-19 pandemic had affected presentation pattern of newly diagnosed T1D patients, manifested by lower number of children diagnosed with T1D and higher percentage of DKA as first presentation compared to the preceding year. Health care services should be at utmost preparedness for possible future waves and other pandemics.
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Research funding: None declared.
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Author contribution: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable. This was retrospective chart review study.
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Ethical approval: Study was approved by Jordan University Hospital Research Ethics Board (no.: 107/2021).
References
1. Zhu, N, Zhang, D, Wang, W, Li, X, Yang, B, Song, J, et al.. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727–33. https://doi.org/10.1056/NEJMoa2001017.Search in Google Scholar PubMed PubMed Central
2. Cucinotta, D, Vanelli, M. WHO declares COVID-19 a pandemic. Acta Biomed 2020;91:157–60. https://doi.org/10.23750/abm.v91i1.9397.Search in Google Scholar PubMed PubMed Central
3. Yusef, D, Hayajneh, W, Awad, S, Momany, S, Khassawneh, B, Samrah, S, et al.. Large outbreak of coronavirus disease among wedding attendees, Jordan. Emerg Infect Dis 2020;6:e19332. https://doi.org/10.3201/eid2609.201469.Search in Google Scholar PubMed PubMed Central
4. Alqutob, R, Al Nsour, M, Tarawneh, MR, Ajlouni, M, Khader, Y, Aqel, I, et al.. COVID-19 crisis in Jordan: response, scenarios, strategies, and recommendations. JMIR Public Health Surveill 2020;6:e19332. https://doi.org/10.2196/preprints.19332.Search in Google Scholar
5. The Official Website of the Jordanian Ministry of Health. Available from: https://corona.moh.gov.jo/ar/MediaCenter [Accessed 10 Mar 2021].Search in Google Scholar
6. Public Health England. Investigation of novel SARS-CoV-2 variant: technical briefing 1. London, United Kingdom: Public Health England; 2020. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/959438/Technical_Briefing_VOC_SH_NJL2_SH2.pdf.Search in Google Scholar
7. DiMeglio, LA, Albanese-O’Neill, A, Muñoz, CE, Maahs, DM. COVID-19 and children with diabetes-updates, unknowns, and next steps: first, do no extrapolation. Diabetes Care 2020;43:2631–4. https://doi.org/10.2337/dci20-0044.Search in Google Scholar PubMed
8. Cherubini, V, Gohil, A, Addala, A, Zanfardino, A, Iafusco, D, Hannon, T, et al.. Unintended consequences of COVID-19: remember general pediatrics. J Pediatr 2020;223:197–8. https://doi.org/10.1016/j.jpeds.2020.05.004.Search in Google Scholar PubMed PubMed Central
9. Wolfsdorf, JI, Glaser, N, Agus, M, Fritsch, M, Hanas, R, Rewers, A, et al.. ISPAD clinical practice consensus guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19:155–77. https://doi.org/10.1111/pedi.12701.Search in Google Scholar PubMed
10. Scaramuzza, A, Tagliaferri, F, Bonetti, L, Soliani, M, Morotti, F, Bellone, S, et al.. Changing admission patterns in paediatric emergency departments during the COVID-19 pandemic. Arch Dis Child 2020;105:704–6. https://doi.org/10.1136/archdischild-2020-319397.Search in Google Scholar PubMed
11. International Society of Pediatric and Adolescent Diabetes (ISPAD). Summary of recommendations regarding COVID-19 in children with diabetes: keep calm and mind your diabetes care and public health advice. Pediatr Diabetes 2020;21:413–4. https://doi.org/10.1111/pedi.13013.Search in Google Scholar PubMed PubMed Central
12. Rabbone, I, Schiaffini, R, Cherubini, V, Maffeis, C, Scaramuzza, A. Diabetes study group of the Italian society for pediatric endocrinology and diabetes. has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children? Diabetes Care 2020;43:2870–2. https://doi.org/10.2337/dc20-1321.Search in Google Scholar PubMed
13. Dayal, D, Gupta, S, Raithatha, D, Jayashree, M. Missing during COVID-19 lockdown: children with onset of type 1 diabetes. Acta Paediatr 2020;109:2144–6. https://doi.org/10.1111/apa.15443.Search in Google Scholar PubMed
14. Tittel, SR, Rosenbauer, J, Kamrath, C, Ziegler, J, Reschke, F, Hammersen, J, et al.. DPV initiative. did the COVID-19 lockdown affect the incidence of pediatric type 1 diabetes in Germany? Diabetes Care 2020;43:e172–3. https://doi.org/10.2337/dc20-1633.Search in Google Scholar PubMed PubMed Central
15. Atlas, G, Rodrigues, F, Moshage, Y, Welch, J, White, M, O’Connell, MA. Presentation of paediatric type 1 diabetes in Melbourne, Australia during the initial stages of the COVID-19 pandemic. J Paediatr Child Health 2020;56:1654–5. https://doi.org/10.1111/jpc.15081.Search in Google Scholar PubMed PubMed Central
16. Unsworth, R, Wallace, S, Oliver, NS, Yeung, S, Kshirsagar, A, Naidu, H, et al.. New-onset type 1 diabetes in children during COVID-19: multicenter regional findings in the U.K. Diabetes Care 2020;43:e170–1. https://doi.org/10.2337/dc20-1551.Search in Google Scholar PubMed
17. Yang, JK, Lin, SS, Ji, XJ, Guo, LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol 2010;47:193–9. https://doi.org/10.1007/s00592-009-0109-4.Search in Google Scholar PubMed PubMed Central
18. Lonnrot, M, Lynch, KF, Elding Larsson, H, Lernmark, Å, Rewers, MJ, Torn, C, et al.. Respiratory infections are temporally associated with initiation of Type 1 Diabetes autoimmunity: the TEDDY study. Diabetologia 2017;60:1931–40. https://doi.org/10.1007/s00125-017-4365-5.Search in Google Scholar PubMed PubMed Central
19. Marchand, L, Pecquet, M, Luyton, C. Type 1 diabetes onset triggered by COVID-19. Acta Diabetol 2020;11:1–2. https://doi.org/10.1007/s00592-020-01570-0.Search in Google Scholar PubMed PubMed Central
20. Ludvigsson, JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020;109:1088–95. https://doi.org/10.1111/apa.15270.Search in Google Scholar PubMed PubMed Central
21. Ebekozien, O, Noor, N, Gallagher, M, Alonso, G. Type 1 diabetes and COVID-19: preliminary findings from a multicenter surveillance study in the U.S. Diabetes Care 2020;43:e83–5. https://doi.org/10.2337/dc20-1088.Search in Google Scholar PubMed PubMed Central
22. Alonso, GT, Corathers, S, Shah, A, Clements, M, Kamboj, M, Sonabend, R, et al.. Establishment of the T1D exchange quality improvement collaborative (T1DX-QI). Clin Diabetes 2020;38:141–51. https://doi.org/10.2337/cd19-0032.Search in Google Scholar PubMed PubMed Central
23. Schober, E, Rami, B, Waldhoer, T. Diabetic ketoacidosis at diagnosis in Austrian children in 1989-2008: a population-based analysis. Diabetologia 2010;53:1057–61. https://doi.org/10.1007/s00125-010-1704-1.Search in Google Scholar
24. Sundaram, PC, Day, E, Kirk, JM. Delayed diagnosis in type 1 diabetes mellitus. Arch Dis Child 2009;94:151–2. https://doi.org/10.1136/adc.2007.133405.Search in Google Scholar
25. Beliard, K, Ebekozien, O, Demeterco-Berggren, C, Alonso, GT, Gallagher, MP, Clements, M, et al.. Increased DKA at presentation among newly diagnosed type 1 diabetes patients with or without COVID-19: data from a multi-site surveillance registry. J Diabetes 2021;13:270–2. https://doi.org/10.1111/1753-0407.13141.Search in Google Scholar
26. Kamrath, C, Mönkemöller, K, Biester, T, Rohrer, TR, Warncke, K, Hammersen, J, et al.. Ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the COVID-19 pandemic in Germany. JAMA 2020;324:801–4. https://doi.org/10.1001/jama.2020.13445.Search in Google Scholar
27. Lawrence, C, Seckold, R, Smart, C, King, BR, Howley, P, Feltrin, R, et al.. Increased paediatric presentations of severe diabetic ketoacidosis in an Australian tertiary centre during the COVID-19 pandemic. Diabet Med 2020;38:e14417. https://doi.org/10.1111/dme.14417.Search in Google Scholar
28. Komulainen, J, Lounamaa, R, Knip, M, Kaprio, EA, Akerblom, HK. Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Arch Dis Child 1996;75:410–5. https://doi.org/10.1136/adc.75.5.410.Search in Google Scholar
29. Rosenbauer, J, Icks, A, Giani, G. Clinical characteristics and predictors of severe ketoacidosis at onset of type 1 diabetes mellitus in children in a North Rhine-Westphalian region, Germany. J Pediatr Endocrinol Metab 2002;15:1137–45. https://doi.org/10.1515/jpem.2002.15.8.1137.Search in Google Scholar
30. Blanc, N, Lucidarme, N, Tubiana-Rufi, N. Factors associated to ketoacidosis at diagnosis of type 1 diabetes in children. Arch Pediatr 2003;10:320–5. https://doi.org/10.1016/S0929-693X(03)00033-2.Search in Google Scholar
31. Bui, H, To, T, Stein, R, Fung, K, Daneman, D. Is diabetic ketoacidosis at disease onset a result of missed diagnosis? J Pediatr 2010;156:472–7. https://doi.org/10.1016/j.jpeds.2009.10.001.Search in Google Scholar PubMed
32. Veijola, R, Reijonen, H, Vähäsalo, P, Sabbah, E, Kulmala, P, Ilonen, J, et al.. HLA-DQB1-defined genetic susceptibility, beta cell autoimmunity, and metabolic characteristics in familial and nonfamilial insulin-dependent diabetes mellitus. J Clin Invest 1996;98:2489–95. https://doi.org/10.1172/JCI119067.Search in Google Scholar PubMed PubMed Central
33. Abdul-Rasoul, M, Al-Mahdi, M, Al-Qattan, H, Al-Tarkait, N, Alkhouly, M, Al-Safi, R, et al.. Ketoacidosis at presentation of type 1 diabetes in children in Kuwait: frequency and clinical characteristics. Pediatr Diabetes 2010;11:351–6. https://doi.org/10.1111/j.1399-5448.2009.00600.x.Search in Google Scholar
34. Quinn, M, Fleischman, A, Rosner, B, Nigrin, DJ, Wolfsdorf, JI. Characteristics at diagnosis of type 1 diabetes in children younger than 6 years. J Pediatr 2006;148:366–71. https://doi.org/10.1016/j.jpeds.2005.10.029.Search in Google Scholar
35. Mallare, JT, Cordice, CC, Ryan, BA, Carey, DE, Kreitzer, PM, Frank, GR. Identifying risk factors for the development of diabetic ketoacidosis in new onset type 1 diabetes mellitus. Clin Pediatr (Phila) 2003;42:591–7. https://doi.org/10.1177/000992280304200704.Search in Google Scholar
36. Smith, CP, Firth, D, Bennett, S, Howard, C, Chisholm, P. Ketoacidosis occurring in newly diagnosed and established diabetic children. Acta Paediatr 1998;87:537–41. https://doi.org/10.1080/08035259850158245.Search in Google Scholar
37. Usher-Smith, JA, Thompson, MJ, Sharp, SJ, Walter, FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ 2011;343:d4092. https://doi.org/10.1136/bmj.d4092.Search in Google Scholar
38. Neu, A, Willasch, A, Ehehalt, S, Hub, R, Ranke, MB, Becker, SA, et al.. Ketoacidosis at onset of type 1 diabetes mellitus in children-frequency and clinical presentation. Pediatr Diabetes 2003;4:77–81. https://doi.org/10.1034/j.1399-5448.2003.00007.x.Search in Google Scholar
39. Sadauskaite-Kuehne, V, Samuelsson, U, Jasinskiene, E, Padaiga, Z, Urbonaite, B, Edenvall, H, et al.. Severity at onset of childhood type 1 diabetes in countries with high and low incidence of the condition. Diabetes Res Clin Pract 2002;55:247–54. https://doi.org/10.1016/s0168-8227(01)00328-x.Search in Google Scholar
40. Peters, AL, Garg, S. The silver lining to COVID-19: avoiding diabetic ketoacidosis admissions with telehealth. Diabetes Technol Ther 2020;22:449–53. https://doi.org/10.1089/dia.2020.0187.Search in Google Scholar PubMed
© 2022 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Original Articles
- The effects of topical iodine containing antiseptics on thyroidal status and early neurodevelopment of preterm infants
- Effect of COVID-19 pandemic on presentation and referral patterns of newly diagnosed children with type 1 diabetes in a developing country
- Influence of the SARS-CoV-2 pandemic on paediatric patients with type 1 diabetes mellitus after one year of follow-up
- Combined diagnostic value of insulin-like growth factor-1, insulin-like growth factor binding protein-3, and baseline luteinizing hormone levels for central precocious puberty in girls
- Differences in the proportion of Croatian adolescents with abnormal individual metabolic syndrome components adjusted to gender and different criterion for individual metabolic syndrome component
- Low HDL-C is a non-fasting marker of insulin resistance in children
- Impact of COVID-19 lockdown on idiopathic central precocious puberty – experience from an Indian centre
- The relationship between metabolic syndrome and bone mineral density in adolescents: analysis of the National Health and Nutrition Examination Survey
- Long-term follow-up of alkaptonuria patients: single center experience
- Local aromatase excess with recruitment of unusual promoters of CYP19A1 gene in prepubertal patients with gynecomastia
- Urinary phthalate concentrations are associated with total fat mass in Thai children
- Clinical profile and aetiologies of delayed puberty: a 15 years’ experience from a tertiary centre in Sudan
- Case Reports
- Congenital generalized lipodystrophy type 4 due to a novel PTRF/CAVIN1 pathogenic variant in a child: effects of metreleptin substitution
- Prepubertal and pubertal gonadal morphology, expression of cell lineage markers and hormonal evaluation in two 46,XY siblings with 17β-hydroxysteroid dehydrogenase 3 deficiency
- Pleomorphism of the HPG axis with NR0B1 gene mutation — a case report of longitudinal follow-up of a proband with central precocious puberty
- Successful treatment of severe hypertriglyceridemia with icosapent ethyl in a case of congenital generalized lipodystrophy type 4
Articles in the same Issue
- Frontmatter
- Original Articles
- The effects of topical iodine containing antiseptics on thyroidal status and early neurodevelopment of preterm infants
- Effect of COVID-19 pandemic on presentation and referral patterns of newly diagnosed children with type 1 diabetes in a developing country
- Influence of the SARS-CoV-2 pandemic on paediatric patients with type 1 diabetes mellitus after one year of follow-up
- Combined diagnostic value of insulin-like growth factor-1, insulin-like growth factor binding protein-3, and baseline luteinizing hormone levels for central precocious puberty in girls
- Differences in the proportion of Croatian adolescents with abnormal individual metabolic syndrome components adjusted to gender and different criterion for individual metabolic syndrome component
- Low HDL-C is a non-fasting marker of insulin resistance in children
- Impact of COVID-19 lockdown on idiopathic central precocious puberty – experience from an Indian centre
- The relationship between metabolic syndrome and bone mineral density in adolescents: analysis of the National Health and Nutrition Examination Survey
- Long-term follow-up of alkaptonuria patients: single center experience
- Local aromatase excess with recruitment of unusual promoters of CYP19A1 gene in prepubertal patients with gynecomastia
- Urinary phthalate concentrations are associated with total fat mass in Thai children
- Clinical profile and aetiologies of delayed puberty: a 15 years’ experience from a tertiary centre in Sudan
- Case Reports
- Congenital generalized lipodystrophy type 4 due to a novel PTRF/CAVIN1 pathogenic variant in a child: effects of metreleptin substitution
- Prepubertal and pubertal gonadal morphology, expression of cell lineage markers and hormonal evaluation in two 46,XY siblings with 17β-hydroxysteroid dehydrogenase 3 deficiency
- Pleomorphism of the HPG axis with NR0B1 gene mutation — a case report of longitudinal follow-up of a proband with central precocious puberty
- Successful treatment of severe hypertriglyceridemia with icosapent ethyl in a case of congenital generalized lipodystrophy type 4
