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The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

2022; Frontiers Media; Volume: 13; Linguagem: Inglês

10.3389/fendo.2022.878634

1664-2392

Valentino Cherubini, Mónica Marino, Andrea Scaramuzza, Valentina Tiberi, A Bobbio, Maurizio Delvecchio, Elvira Piccinno, Federica Ortolani, Stefania Innaurato, Barbara Felappi, Francesco Gallo, Carlo Ripoli, Maria Rossella Ricciardi, Filomena Pascarella, Filomena A. Stamati, Felice Citriniti, Claudia Arnaldi, Sara Monti, Vanna Graziani, Fiorella De Berardinis, Cosimo Giannini, Francesco Chiarelli, Maria Zampolli, Rosaria De Marco, Giulia Bracciolini, Caterina Grosso, Valeria Donno, Barbara Piccini, Sonia Toni, Susanna Coccioli, Giuliana Cardinale, Marta Bassi, Nicola Minuto, Giuseppe d’Annunzio, Claudio Maffeis, Marco Marigliano, Angela Zanfardino, Dario Iafusco, Assunta S. Rollato, Alessia Piscopo, Stefano Curto, Fortunato Lombardo, Bruno Bombaci, Silvia Sordelli, Chiara Mameli, Maddalena Macedoni, Andrea Rigamonti, Riccardo Bonfanti, Giulio Frontino, Barbara Predieri, Patrizia Bruzzi, Enza Mozzillo, Francesco Maria Rosanio, Adriana Franzese, Gavina Piredda, Francesca Cardella, Brunella Iovane, Valeria Calcaterra, Maria Giulia Berioli, Anna Lasagni, Valentina Pampanini, Patrizia Ippolita Patera, Riccardo Schiaffini, Irene Rutigliano, Tullio Meloni, Luisa De Sanctis, Davide Tinti, Michela Trada, L Guerraggio, Roberto Franceschi, Vittoria Cauvin, Gianluca Tornese, Francesca Franco, Gianluca Musolino, Giulio Maltoni, Valentina Talarico, Antonio Iannilli, Lorenzo Lenzi, Maria Cristina Matteoli, Edoardo Pozzi, Carlo Moretti, Stefano Zucchini, Ivana Rabbone, Rosaria Gesuita,

Diabetes Management and Research

Aim/Hypothesis To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019. Methods Forty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019. Results Overall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p<0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p<0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively). Conclusions/Interpretation There was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.