key: cord-0889797-ihivklqz
authors: Delpeut, Juliette; Giani, Elisa; Louet, Dalila; de Kerdanet, Marc; Choleau, Carine; Beltrand, Jacques
title: Variable incidence of ketoacidosis in youth with type 1 diabetes onset during Covid-19 pandemic peaks in France
date: 2022-01-10
journal: Diabetes Metab
DOI: 10.1016/j.diabet.2022.101322
sha: 6adc5fb1333c73554a2294a4ac60c6669d04af59
doc_id: 889797
cord_uid: ihivklqz

nan

Variable incidence of ketoacidosis in youth with type 1 diabetes onset during

Running Title: Covid-19 on Diabetes Type 1 Onset Juliette Delpeut*, MD 1 , Elisa Giani*, MD PhD 2-4 , Dalila Louet, MSc 5 , Marc de Kerdanet, MD 5, 6 , Carine Choleau, PhD 5 , Jacques Beltrand MD PhD [3] [4] [5] 7 , the AJD Study Group (see appendix on line)

Affiliations : During the 2020 coronavirus pandemic peak, several groups described a delay in the diagnosis of type 1 diabetes in youth, resulting in an increased rate of ketoacidosis (DKA) [1] [2] [3] [4] [5] . This probably reflects the fear of approaching medical services and the pandemic-related redistribution of healthcare resources [6] . After a year and half of Covid pandemic in Europe, its impact on access to healthcare services for an early diagnosis of type 1 diabetes should be assessed.

We examined the frequency and severity of DKA in youth at diagnosis of type October to November (curfew and partial lockdown) were compared with the same periods of the previous years. Differences are presented as incidence rate ratio (IRR) with 95% confidence intervals (CIs). A two-sided P < .05 was considered statistically significant. (Table I) .

Similarly, the rate of severe DKA was higher in 2020, accounting for 18.5% of the cases compared to 13.2% in 2019 (P < .001), and 14.9% in 2018 (P = 0.006) and 11.8% in 2017 (P < 0.001).

During the first lockdownmid-March to mid-May 2020the rate of youth with DKA was significantly higher compared with the same periods in 2019 (51.5% During the second national lockdown in October-November 2020, the rate of DKA and severe DKA were similar to the same period of the previous years (Table I) .

This study confirmed the increased rate of DKA and severe DKA in youth at onset of type 1 diabetes in 2020 compared to the previous years. Analysis of monthly rates reported an increase of DKA cases during the first pandemic peak and concomitant lockdown (mid-March to mid-May), as previously described [1] [2] [3] [4] . Our data highlighted a persistent increase in the DKA rate in June and July, although Covid-19 incidence decreased. This suggests that the delayed diagnosis may be due to the fear of accessing medical units more than to a reduction in clinical services related to the national restrictions.

Moreover, this study did not find an increased DKA rate during the second pandemic peak (October-November), although no specific national campaign was run to encourage families not to delay medical consultations for their children after the first lockdown. One possible explanation is reduced fear of families for approaching healthcare services or, possibly, better accessibility to routine visits. These results are in line with national data previously published and are supported by the strenght of the national registry and the annual incidence rates [8] . Limitations of this study include the lack of socio-demographics and Covid-19 infectious data for youths for the periods of interest. Further research to better define the causes for the increased DKA rates during the pandemic is needed for a future implementation of prompt diagnostic programs.

Supplementary materials (Appendix) associated with this article can be found at http://www.scincedirect.com at doi . . .

The authors thank the scientific commission of the AJD for the collection and the registry data management.

The Register of the Aide aux Jeunes Diabétiques (AJD) is supported by families of children and adolescents with diabetes.

No potential conflicts of interest relevant to this article were reported. 

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?

Ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the COVID-19 pandemic in Germany

Newonset type 1 diabetes in children during COVID-19: multicenter regional findings in the

Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic

Increased frequency of severe diabetic ketoacidosis at type 1 diabetes onset among children during COVID-19 pandemic lockdown: an observational cohort study

Delayed access or provision of care in Italy resulting from fear of COVID-19

Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

Trends in childhood type 1 diabetes incidence in France