ABSTRACT
Background and Aims: There has been a considerable impact of the COVID-19 pandemic on healthcare services and the management of type 1 diabetes (T1D) at onset. The aim is to describe the clinical characteristics of children with T1D onset in Kuwait during the two years of the COVID-19 pandemic in comparison to the previous years (2017-2019) Methods: Children aged 14 years or less diagnosed with T1D onset between the years (2017-2022) were included. Children were categorized according to the diagnosis year and during (Feb 24th- Feb 23rd,the following year) Results: A significant increase in DKA rates was observed during the first & second years of the pandemic compared to the previous years (2020, 53.3%, 2021, 55.8% vs 2019, 39.4%, 2018,35.5%, 2017,39.1%,p-value=>0.001respectively);as well as ICU admission (26.4% in 2020,27.6% in 2021,13.9% in 2019,15.0% in 2018, and 19.7% in 2017, p-value = 0.002 respectively). Frequency of TTG-IgA antibodies was slightly higher in the second year compared to the previous years (12.4% in 2021,9.3% in 2020,8.8% in 2019,9.8% in 2018, and 6.0% in 2017,p-value = 0.06 respectively). Frequency of TPO antibodies didn't differ across the years (20.0% in 2021, 22.6% in 2020,14.8% in 2019,12.7% in 2018, and 16.0% in 2017,p-value = 0.06 respectively, p-value = 0.10, respectively) Conclusion(s): DKA & ICU admission rates continue to rise in the second year of the pandemic. In 2021,celiac screening positivity was slightly higher at onset. To better understand the longterm effects of the pandemic on the clinical course of children with T1D, it is essential to evaluate further clinical presentation, autoimmune involvement & outcomes over long periods of time.
ABSTRACT
Background: The first COVID-19 case was reported in Kuwait in February 2020, and the pandemic rapidly spread in the country. To better understand the impact of COVID-19 on children, a pediatric registry was established, recording all cases of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in children, focusing on disease presentation, complications, severity of the disease and early outcomes. Methods: A retrospective, national-level, cohort study was performed and included all children aged ≤ 12 years with a confirmed SARS-CoV2 infection by polymerase chain reaction (PCR) in Kuwait between February 24th to December 31st, 2020. Cases were identified through reviewing national electronic SARS-CoV-2 testing, hospital admission records, and medical transfer services. During the study period infected children were identified through symptomatic testing, contact tracing, routine screening upon hospitalization, and screening before and after travel. Children who were older than 12 years at the time of sample collection or had equivocal RT-PCR result were excluded. Also, patients who had positive SARS-CoV-2 specific antibodies without documentation of positive SARS-CoV-2 RT-PCR were excluded in the analysis. Patient demographics, medical history, SARS-CoV-2 testing, signs and symptoms, therapeutic and medical intervention, complications, laboratory tests and outcome were obtained using The Kuwait Pediatric COVID-19 Registry (PCR-Q8). Descriptive analysis was performed. Results: During the study period, a total of 14,322 children aged ≤12 were diagnosed with SARS-CoV-2 infection in Kuwait. The first pediatric case was reported in March 2020. The monthly number of cases peaked during the summer of 2020 (July-September), and this was followed by a rapid decline during the beginning of winter of 2020 (figure 1). The median age was 7.6 years (IQR 4.1- 10.5) and half were male. Less than one-third (29.4%) were symptomatic (table 1). The number of children with pre-existing comorbidities was 228 (1.59%);the most common comorbidities were asthma (54, 0.37%), chronic neurological disorder (29, 0.2%) and acquired/congenital heart disease (25, 0.17%). The number of hospitalized children was 1599 (11.2%). The most common symptoms of those who were hospitalized were fever (39.8%), cough (17.6%), runny nose (11.1%) and diarrhea (8.4%). A total of 32 children were admitted to intensive care (0.22%), and 5 deaths were recorded (0.035%). Conclusion: Overall, the pediatric COVID-19 registry has invaluable information about the effect of COVID-19 on children in Kuwait. Such information can guide clinical practices for better understanding and management of COVID-19 in children.
ABSTRACT
Background: The rising incidence of diabetes mellites is a growing health concern in Kuwait, placing an overwhelming burden on the healthcare system. The overall prevalence of diabetes was estimated to be 19.1% according to last published data in 2020. As a result, the Kuwait National Diabetes Registry (KNDR) was established in the year 2018 by the Ministry of Health in collaboration with the Dasman Diabetes Institute to provide insight on the nature of the disease in this population. Aim: The aim of establishing the national web-based registry is to provide a sound database to investigate disease diagnosis, management, and outcomes and enable evaluation of clinical improvement focusing on identifying risk factors, treatment interventions and disease complications and assess morbidity in the adult and pediatric population. Method: Patients of all ages and nationalities residing in Kuwait diagnosed with any form of diabetes (type 1, type 2, gestational and atypical) were included in the KNDR. Data sources include electronic health records from primary healthcare centers (PHC), hospital outpatient clinics, Kuwait Diabetes Society (KDS) and patient self-register on the webpage. The register includes data on demographics, diabetes type, comorbidities, smoking habits, treatment modality, blood pressure, weight, height, and blood profile including glucose status, renal and lipid profile. Patient data was collected from one governorate as a pilot phase before extending the platform to other regions in Kuwait. Descriptive analysis was performed. Results: A sample of 36,447 patients with diabetes from PHCs in one Kuwaiti governorate, Al-Farwaniyah, collected from September 2019 to March 2020 (pre-SARS-CoV-2 pandemic) was studied. The median age was 54 years, most were men (63.4%), 33.4% were Kuwaiti and 11.3 % were smokers. The majority had type 2 diabetes (82.3%) and hypertension and dyslipidemia were found in 20.2% and 22.2% of the population, respectively. Over half the population (56.4%) with type 2 diabetes were on oral medication only, 3.7% on insulin only, 21.8% on oral and insulin medication and 18.1% were not on any medication and were recommended lifestyle modifications. Of the patients on insulin 60% were using long acting and 30% were using mixed insulin. In the registry, only 20% of those who have diabetes have a recorded HbA1c. Discussion: Creating a diabetes registry gathers invaluable information, aids as an essential tool for monitoring patients with diabetes and supports planning better healthcare services. However, the high missing data requires increased physician data entry training and improved and incorporated hospital information systems into the registry to ensure high ascertainment. The registry can be utilized to estimate incidence and prevalence, to translate into policy and improve standard of care.
ABSTRACT
Introduction: The COVID-19 pandemic had affected the access to the healthcare facilities across the globe. In Kuwait, first wave of COVID- 19 pandemic was announced on February 24th, 2020. Kuwait has implemented public health measures including total lockdowns, unavailability of the diabetes clinics, and limited access to the hospitals. The second wave of COVID-19 pandemic was declared on March 7th, 2021. Virtual visits, clinics availability, and easier access to the hospitals might change DKA at presentation and ICU admission in newly diagnosed children with T1D in the second wave Objectives: To compare DKA presentation and ICU admission in newly diagnosed children with T1D during the first and second waves of COVID-19 pandemic using data from Childhood Onset Diabetes electronic Registry (CODeR) Methods: Data were extracted from CODeR. Patients aged less than 14 years at diagnosis during (Feb 24th-May 30th) in 2020 and 2021 were included Results: Total number of children with T1D between (Feb-May) in 2020 were 54 children compared to 97 in the same period in 2021. There was no significant difference between the HbA1c levels in both periods (11.56±2.1 vs 11.64± 2.2;p=0.84) and the frequency of DKA among both groups as well (53.7% vs 47.47%;p=0.53). However, there was a slight decrease in the frequency of moderate DKA (48.26% in 2020 vs 27.65% in 2021;p=0.08). No significant changes were reported in the frequency of mild or severe DKA presentation in both groups (65.9% vs 72.4%;p=0.61) and requirement of ICU admission (11.11% vs 16.49%;p=0.36) Conclusions: Although there has been a slight decrease in the number of patients presented with moderate DKA in 2021 compared to the same period in 2020. However, severe DKA rates and requirement of ICU admission didn't differ in both periods. Future studies to explore frequency of DKA, ICU admission, and other possible factors are needed over a longer periods for a better understanding of the impact of COVID-19 pandemic on DKA as they change as the COVID-19 pandemic continues.
ABSTRACT
Introduction: The COVID-19 pandemic brought forth distressing challenges in numerous countries including Kuwait. To minimize the spread of the virus, lockdowns were imposed through closure of schools and the enforcement of social distancing. T1D children may be critically impacted during this period due to these restrictions. To maintain efficient disease management and outcomes, virtual diabetes clinics were implemented. Objectives: This study aimed to evaluate glycemic control of T1D children and its association with demographic variables before and during the pandemic. Methods: A convenient sample of children and their parents were randomly selected from the Childhood-Onset Diabetes electronic Registry (CODeR). Patient demographics and diabetes history were obtained through phone calls and direct interviews. HbA1c results were recorded after reviewing medical charts of 12-month periods before and during the pandemic (Feb 24, 2019-Feb 23, 2020 vs Feb 24, 2020-Feb 24, 2021) and compared to evaluate glycemic control. Results: Forty-nine children with T1D (age 9.3±3.2 years, 44.9% males, diabetes duration 3.5±1.9 years) participated in the survey. Majority of patients were receiving multiple daily injection therapy (88.9%) compared to continuous subcutaneous insulin infusion therapy (11.1%). No significant changes in HbA1c results prior to and during the pandemic (10.01%±1.72 vs 9.66%±1.59, p>0.05) were observed. Gender, nationality and age did not affect glycemic variations during the two time periods. However, children with a shorter diabetes duration (<5 yrs) showed slightly improved HbA1c results during the pandemic (9.89%±1.71 vs 9.66%±1.68, p=0.04). Conclusions: Virtual diabetes clinics may have allowed patients frequent contact with their physicians and facilitates communication from home environments which resulted in insignificant improvement of metabolic status. These are preliminary findings on T1D children in Kuwait and future studies are necessary to evaluate glycemic outcomes prior to and during the pandemic.