ABSTRACT
Background: COVID19 Lockdown resulted in an extreme change in daily lifestyle with a significant increase in weight and loss of quality of life, as well as an increase in the risk of secondary health conditions even in young people. One reason for this is a fatal change in the nutritional situation, especially among adolescents. Convincing models to counter this problem are missing so far. Multiprofessional training programs could reveal an outstanding effect for secondary prevention of obesity in youth. Telehealth measures were successfully implemented several times during the COVID19 pandemic. Method(s): Adolescents (8-17 years) with severe obesity referred through a large obesity consultation were interviewed using standardized dietary behavior questionnaires (FEV-K, FFL-K, FFV-K) and quality of life questionnaires (WHO-5, KIND-L) and enrolled in a structured multimodal education program for adolescents with overweight. The program content (sports, nutrition, medicine, psychology) was tought exclusively video-based. After the end of the program (12 months), the patients were interviewed again regarding eating behavior and quality of life. In addition, a clinical examination including analysis of blood parameters was performed before and after the program. The results were analyzed and compared with results from the pre-pandemic period (2017 - 2019). Result(s): 108 children and adolescents (mean age 12.1 yrs;male 46.2%, BMI SDS 2.21) were studied and telemedicated. Based on a significantly increased intake of fatty and sugary foods and an increased amount of meals per day (7.2 meals per day), a significantly increased intake of vegetables and fruits as well as a massive decrease of sweets, snacks and soft drinks was observed after program participation, which corresponds to a significant improvement in dietary behavior also compared to the pre-pandemic period. The amount of meals per day decreased to 4.1 meals per day. The quality of life of the adolescents increased significantly. The BMI SDS and the blood parameters (cholesterol, triglycerides, HOMA index) showed a decreasing trend, which roughly corresponds to the effect of the pre-pandemic period. Discussion and Conclusion(s): This study demonstrated a beneficial effect on dietary behaviors and quality of life of adolescents with obesity during lockdown through video-based structured education. Future research needs to show the extent to which this effect is replicable with respect to new periods of contact restriction. It is possible that telemedicine obesity education components can reach a large number of patients and especially families in rural areas, and thus can be a supraregional support for adolescents with obesity.
ABSTRACT
Objectives: During the COVID-19 pandemic, a significantly lower rate of health care usage was reported, potentially leading to delayed medical care. Diabetic ketoacidosis is an acute life-threatening complication of a delayed diagnosis in type 1 diabetes. Methods: We conducted a nationwide retrospective survey to investigate the frequency of diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in Germany from March 13, when most federal states closed kindergartens and schools in order to reduce interpersonal contacts, through May 13, 2020. The estimated frequencies of diabetic ketoacidosis and severe diabetic ketoacidosis observed during the COVID-19 period and during the same periods in 2018 and 2019 were adjusted for age, sex, and migration background, and were compared by multivariable logistic regression analysis. Results: We obtained and analyzed data of 532 children and adolescents with newly diagnosed type 1 diabetes from March 13 through May 13, 2020, from 217 diabetes centers participating in the German DPV register. Compared with the pre-COVID-19 periods, the mean estimated proportion of diabetic ketoacidosis and severe diabetic ketoacidosis increased during the COVID-19 period by 84.7% (95% confidence interval (CI), 59.6% to113.8%;p < 0.0001) and 45.3% (95% CI, 14.5% to 84.3%;p = 0.002), respectively. Young children showed the highest risk for diabetic ketoacidosis and severe diabetic ketoacidosis during the COVID-19 pandemic. Conclusions: Delayed access to health care in Germany during the COVID-19 pandemic might explain the significant increase in ketoacidosis at diabetes diagnosis in children. Our results raise the question whether delayed diagnosis during the COVID-19 pandemic may also have harmed patients with other diseases.