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 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 alarming spread of the COVID-19 virus caused governments to impose imperative lockdowns and quarantines which negatively impacted vulnerable Type 1 diabetes children. Objectives: The study aim was to assess glycemic status and healthrelated quality of life (HRQoL) during the pandemic in a cohort of children with Type 1 diabetes (T1D) in Kuwait. Methods: Patients (aged 2-18) and their parents were recruited from the Childhood-Onset Diabetes electronic Registry (CODeR) and government hospitals. The Pediatric Quality of Life Inventory (PedsQL™) 3.0 Diabetes Module was used to evaluate disease specific total HRQoL through parent-proxy and self-reports. HbA1c results between February 24, 2020 and March 24, 2021 were collected from hospital records to assess glycemic status. Results: A total of 150 patients were included in the study (age 9.5 ±3.5 years, 51% males, diabetes duration 3.4±2.3 years). From the surveyed participants, 119 (84%) were on multiple daily injections, 26 (19%) had T1D family history and 132 (90%) were cared by both parents. Determined from 59 available results, mean HbA1c was 9.78%±1.61. Parent-proxy and patient HRQoL reports were similar in score (73.1±13.9 and 73.3±11.8). Patients reported lower QoL in the diabetes symptoms domain (p=0.04) and a higher QoL in the treatment barriers domain (p=0.002). Gender, nationality, and age did not affect HRQoL. Pump therapy and longer diabetes duration (>3 years) were associated with higher parent-proxy total HRQoL (p=0.01, p=0.03). Patients cared by both parents had slightly better glycemic status (9.6%±1.5 vs 10.9%±2.3) and better QoL scores in the diabetes symptoms domain (p=0.04). No statistical association was found between either HbA1c or COVID-19 history and total HRQoL. Conclusions: In this study, history of personal or family COVID-19 infection did not affect HRQoL. However, special support needs to be given to patients recently diagnosed with T1D, cared for by single parents, and treated with MDI to have a better HRQoL during the pandemic.
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.