Diabetic ketoacidosis incidence among children with new‐onset type 1 diabetes in Poland and its association with COVID‐19 outbreak—Two‐year cross‐sectional national observation by PolPeDiab Study Group

Background There are several observations that the onset of coronavirus 19 (COVID‐19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country‐specific healthcare policies, more national‐level evidence is nee...

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Published in:	Pediatric diabetes Vol. 23; no. 7; pp. 944 - 955
Main Authors:	Pietrzak, Iwona, Michalak, Arkadiusz, Seget, Sebastian, Bednarska, Maria, Beń‐Skowronek, Iwona, Bossowski, Artur, Chobot, Agata, Dżygało, Katarzyna, Głowińska‐Olszewska, Barbara, Górnicka, Martyna, Horodnicka‐Józwa, Anita, Jakubek‐Kipa, Katarzyna, Jarosz‐Chobot, Przemysława, Marcinkiewicz, Katarzyna, Mazur, Artur, Myśliwiec, Małgorzata, Nazim, Joanna, Niechciał, Elżbieta, Noczyńska, Anna, Rusak, Ewa, Seifert, Monika, Skotarczyk‐Kowalska, Elżbieta, Skowronek, Anna, Szypowska, Agnieszka, Wais, Paulina, Walczak, Mieczysław, Wołoszyn‐Durkiewicz, Anna, Wysocka‐Mincewicz, Marta, Zubkiewicz‐Kucharska, Agnieszka, Szadkowska, Agnieszka
Format:	Journal Article
Language:	English
Published:	Former Munksgaard John Wiley & Sons A/S 01-11-2022 Wiley Subscription Services, Inc
Subjects:	Children Coronaviruses COVID-19 Diabetes Diabetes mellitus (insulin dependent) Diabetic ketoacidosis Ketoacidosis Mechanical ventilation new‐onset diabetes Original Pandemics Poland type 1 diabetes Poland COVID-19 Poland type 1 diabetes new-onset diabetes diabetic ketoacidosis children
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Summary:	Background There are several observations that the onset of coronavirus 19 (COVID‐19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country‐specific healthcare policies, more national‐level evidence is needed to provide generalizable conclusions. Objective To compare the rate of DKA in Polish children diagnosed with type 1 diabetes (T1D) between the first year of COVID‐19 pandemic (15 March 2020 to 15 March 2021) and the preceding year (15 March 2019 to 15 March 2020). Methods Reference centers in 13 regions (covering ~88% of Polish children) retrospectively reported all new‐onset T1D cases in children from assessed periods, including DKA status at admission, administered procedures and outcomes. Secondly, we collected regions' demographic characteristics and the daily‐reported number of COVID‐19‐related deaths in each region. Results We recorded 3062 cases of new‐onset T1D (53.3% boys, mean age 9.5 ± 4.3 years old) of which 1347 (44%) had DKA. Comparing pre‐ and post‐COVID‐19 period, we observed a significant increase in the rate of DKA (37.5%–49.4%, p < .0001). The fraction of moderate (+5.4%) and severe (+3.4%) DKA cases increased significantly (p = .0089), and more episodes required assisted ventilation (+2.1%, p = .0337). Two episodes of DKA during 2020/2021 period were fatal. By region, change in DKA frequency correlated with initial COVID‐19 death toll (March/April 2020) (R = .6, p = .0287) and change in T1D incidence (R = .7, p = .0080). Conclusions The clinical picture of new‐onset children T1D in Poland deteriorated over a 2‐year period. The observed increase in the frequency of DKA and its severity were significantly associated with the overlapping timing of the COVID‐19 epidemic.
Bibliography:	Iwona Pietrzak and Arkadiusz Michalak are co‐first authors. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1399-543X 1399-5448
DOI:	10.1111/pedi.13379