Incidence and presentation of new-onset type 1 diabetes in children and adolescents from Germany during the COVID-19 pandemic 2020 and 2021: Current data from the DPV Registry.

AIMS: To determine whether the incidence of type 1 diabetes mellitus (T1D), autoantibody-negative diabetes, and diabetic ketoacidosis (DKA) at diabetes onset in 2020 and 2021 changed when compared to long-standing trends. METHODS: Our study is based on diabetes manifestation data of the 0.5-<18-year-old children/adolescents from the German multicenter Diabetes Prospective Follow-up Registry. Based on long-term pre-pandemic trends from 2011 to 2019, we estimated adjusted incidence rate ratios (IRR) for T1D and DKA, and prevalence rate ratios (PRR) regarding autoantibody status with 95 % confidence intervals (CI) for the years 2020 and 2021 (observed versus predicted rates), using multivariable negative binomial or beta-binomial regression, respectively. RESULTS: We analyzed data of 30,840 children and adolescents with new-onset T1D. The observed incidences were significantly higher than the predicted incidences (IRR2020 1.13 [1.08-1.19]; IRR2021 1.20 [1.15-1.26]). The prevalence of autoantibody-negative diabetes did not change (PRR2020 0.91 [0.75-1.10]; PRR2021 1.03 [0.86-1.24]). The incidence of DKA during the pandemic was higher than predicted (IRR2020 1.34 [1.23-1.46]; IRR2021 1.37 [1.26-1.49]). CONCLUSIONS: An increase in the incidences of T1D and DKA, but not of autoantibody-negative diabetes was observed during both pandemic years. Further monitoring and efforts for DKA prevention at onset are necessary.

Rehabilitation of children and adolescents with diabetes during Coronavirus Pandemic in comparison to the year before the pandemic

Background during the pandemic a decrease of more than 30% of pediatric rehabilitations was seen in the year 2020. These data are are provided by the German Rentenversicherung (DRV). DRV is not the only provider of pediatric rehabilitations. DPV database can analyse data independent of the funding provider and a comparison of the prepandemic year with the pandemic years 2020/21 can be performed. Methods Comparison of inpatient rehabilitation of 11 pediatric rehabilitation clinics in the years 2019 (pre pandemic) and 2020/21. Monthly analysis of number of admissions, duration of stay, HbA1c, and BMI development. Comparison of rehabilitation in east and west German clinics and subanalysis of age below and above 12 years. Results In 2019 in total 2237 children and adolescents with type 1 diabetes were admitted, in 2020 a reduction to 1455 (-35%) and no improvement in 2021 (n=1447) was seen. A dramatic decrease was evident in April and May 2020 during the first lockdown. During the first lockdown the duration of stay in the clinic was siginificantly reduced. The eastern German clinics remained with more stable admissions in this period. HbA1c showed a significant increase during the first lockdown (April 2019: 8.19% (7.94, 8.44);April 2020: 8.68% (8.25, 9.11);April 2021 7.94% (7.63, 8.24)). The age stratified analysis showed a higher HbAc1 level in the adolescents compared to the children. BMI-SDS was 0.29 (0.24, 0.33) in 2019, increased to 0.35 (0.29;0.41) in 2020 and further increased to 0.41 (0.35;0.46) in 2021. Conclusion We saw a significant reduction of the number of pediatric diabetes rehabilitations in the Coronavirus Pandemic and no improvment of this decrease during 2021.

COVID-19 Lockdown Periods in 2020: Good Maintenance of Metabolic Control in Adults with Type 1 and Type 2 Diabetes.

During the COVID-19 pandemic, there were increased concerns about glycemic control in patients with diabetes. Therefore, we aimed to assess changes in diabetes management during the COVID-19 lockdown for patients with type 1 or type 2 diabetes mellitus (T1DM, T2DM) in Germany. We included data from 24,623 patients (age>18 years) with T1DM (N=6,975) or T2DM (N=17,648) with documented data in 2019 and 2020 from the multicenter Diabetes-Prospective Follow-up registry (DPV). We conducted a groupwise comparison of identical patients in 2019 and 2020 for different time periods of pandemia. Pairwise differences of continuous parameters of treatment modalities and metabolic outcome between 2019 and 2020 were adjusted for seasonality, age, and diabetes duration. We presented these outcomes as adjusted medians with 95% confidence intervals. Rates were compared using negative-binomial models, dichotomous outcomes were compared using logistic models. Models were additionally adjusted for age and diabetes duration. These outcomes were presented as least-square means with 95% confidence intervals, p-values of<.05 were considered significant.In participants with T1DM, CGI (combined glucose indicator) increased only by 0.11-0.12% in all time periods of 2020 compared to 2019 (all p<0.001) while BMI decreased slightly by -(0.09-0.10) kg/m² (p<0.0001). In participants with T2DM, HbA1c increased by 0.12%, while BMI decreased slightly by -(0.05-0.06) kg/m² (p<0.0001).During the COVID-19 lockdown period, patients with T1DM and T2DM experienced only clinically insignificant changes in glucose control or body weight. Despite lockdown restrictions, patients were able to maintain metabolic control.

Did the SARS-CoV-2 lockdown affect the incidence of pediatric type 1 diabetes in Germany?

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).