ABSTRACT
Objectives: To analyze a possible change in pediatric type 1 diabetes (T1D) incidence rate (IR) following the SARS-CoV-2 outbreak in comparison with the IRs of the last decade in Germany. Viral infections are known to be associated with T1D risk. Thus the SARS-CoV-2 pandemic may have increased the risk of T1D onset. Additionally, social separation in the SARS-CoV-2 lockdown may have set stress on families also possibly increasing the risk of T1D onset. On the other hand, social separation during lockdown may have decreased the frequency of common infections in children possibly reducing the T1D onset risk. Methods: We included T1D patients registered in the “Diabetes- Prospective Follow-up” registry (DPV) with onset age between 6 months and < 18 years diagnosed in the years 2011-2020 each between March 13th and May 13th, corresponding to the lockdownperiod in Germany in 2020. In each year, the number of cases was related to the respective patient-years at risk to estimate the IR (per 100,000 person-years [95% confidence intervals]) obtained from the Federal Statistical Office. Using a Poisson regression model, we predicted the IR for 2020 based on data from 2011-2019 in the whole cohort, and stratified by sex and age groups (< 6, 6- < 12, 12- < 18 years). Results: T1D IRs increased from 16.4 [14.7-18.2] in 2011 to 22.2 [20.3-24.2] in 2019 (p = 0.04). The IR in 2020, based on 532 cases among 13 million subjects <18 years, was 23.4 [21.5-25.5] and did not differ significantly from the predicted IR (22.1 [20.4-23.9]) (Figure 1). We found no significant deviation of T1D IRs in 2020 from the predicted IRs after stratifying by age and sex. Conclusions: The T1D IR in 2020 follows the increasing trend in the past decade without up- or downwards deviation, indicating no shortterm influence of the SARS-CoV-2 situation on T1D IR. SARS-CoV-2 infection rates in Germany were relatively low, so direct diabetogenic effects are unlikely. (Table Presented).
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.