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Background: At present few data have clearly showed an increased frequency of idiopathic central precocious puberty (CPP) in females during the COVID-19 pandemic. The role of environmental factors is not fully understood and various hypotheses have been formulated. Aims of the Study: To evaluate retrospectively the incidence of newly diagnosed CPP and other pubertal disorders (premature thelarche, early puberty, fast puberty and precocious menarche) in two regions of Italy (Tuscany and Emilia-Romagna) during and after the lockdown for COVID-19. Patients and Methods: The study included 440 females evaluated for pubertal disorders into the Centres of Florence, Parma, Reggio Emilia and Modena between the 1 January 2020 into the 31 December 2021. Subjects with endocrine or chronic diseases were excluded. Monthly incidence rates and clinical features were compared with a control group of patients evaluated for the same problems into 2019. Result(s): Our data confirmed a higher frequency of CPP in females (261 patients, mean age 7.6 +/- 0.6 years, without significant differences between the diagnoses carried out in 2020 and 2021) compared to 2019 (52 cases, mean age 7.5 +/- 0.7 years, p < 0.0001). Interestingly, CPP cases were significantly higher also in the first two months of 2020, so before the start of Italian lockdown and just before the Sars-COV-2 pandemic was declared (21 cases vs. 7 in the same period of 2019;p < 0.0001). Our preliminar data seem also to suggest an increased frequency of the diagnoses of premature thelarche (54 patients in 2021 and 31 patients in 2020 vs 21 patients in 2019, respectively p < 0.0001 and < 0.05;between 2020 and 2021: p < 0.0001), early puberty (31 patients in 2021 and 25 patients in 2020 vs 16 patients in 2019, respectively p < 0.0001 and p < 0.05), fast puberty (20 patients in 2020 vs 5 patients in 2019 and 2021;respectively, p < 0.0001) and precocious menarche (9 patients in 2021 vs 3 patients in 2019 and 4 patients in 2020;p < 0.0001). Conclusion(s): Our data, on the one hand, confirm an increase in the frequency of new cases of CPP during and after the lockdown for COVID-19 pandemic, but also show an increase, albeit differently distributed in these 2 years of epidemic, in other pubertal development disorders. Interestingly, this could delineate different factors involved in the genesis of these disorders. Further studies and insights appear necessary to better explain these aspects.
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Introduction: The true incidence of SARS-CoV-2 infection in children and young people (CYP) is unclear and data are influenced by testing strategies. CYP have so far accounted for 17.5- 22% of diagnosed infections. In adults, diabetes was identified as risk factor for severe symptoms and hospitalization with the COVID-19. Eighteen months into the pandemic, studies in CYP with type 1 diabetes (T1D) reported only an increased prevalence of diabetic ketoacidosis (DKA) at T1D onset. Objective(s): To investigate the prevalence and clinical characteristics of SARS-CoV-2 infection in CYP with T1D. Method(s): SARS-CoV-2 infection was defined according to self-reported previous SARS-CoV-2 nasal swab PCR results in 210 CYP followed during 18 months of the pandemic and seroprevalence of antibodies against the SARS-CoV-2 spike protein assessed in 85 CYP (previous negative nasal swab PCR or never performed) from January to June 2021, before COVID-19 vaccination era. SARS-CoV-2 IgG were assessed using a chemiluminescent immunoassay (CLIA). Data on clinical characteristics as well as glycemic control were collected before (T0) and 3-months after (T1) infection. Result(s): SARS-CoV-2 infection was detected in 39 patients (males 61.5%;median age 13.5 and T1D duration 5.49 yrs.) during second and third wave: 26 (66.6%) based on the self-reported nasal swab PCR results and 13 (33.4%) on the SARS-CoV-2 IgG assay. All patients detected by CLIA were asymptomatic. Four patients detected by nasal swab PCR were asymptomatic (15.4%). Other patients reported >=1 symptoms lasting a median of 5 days and including: fever (46.1%), headache (28.2%), anosmia and/or ageusia (25.6%), nasal congestion (15.4%), and fatigue/myalgia (10.2%). Dry cough, pharyngeal erythema, nausea and/or vomiting, diarrhea, abdominal pain, and arthralgia were less reported (2.56%). None had dyspnea, skin lesion, and MIS-C. Hospitalizations, DKA, and severe hypoglycemic events were not recorded. Glycemic control was not impaired from T0 to T1 (see Table). Conclusion(s): We found evidence for increased prevalence of SARS-CoV-2 infection among CYP with T1D using antibodies against the SARS-CoV-2 spike protein assessment. Asymptomatic subjects were 43%. COVID-19 pandemic had no impact on glycemic control and acute complications. Our data suggest that serological assay is useful to diagnose previous SARS-CoV-2 infection in not vaccinated CYP and to reconstruct the disease prevalence.
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Introduction: Italy was the first EU country to be affected by COVID-19 outbreak. The sudden change in everyday life was challenging for children and young people (CYP) who rely heavily on peer connections for emotional and social support. Concerns for consequences in CYP with type 1 diabetes (T1D) rose. Objective(s): To compare the diabetes-specific health-related quality of life (D-HRQOL) of CYP with T1D and their parents and the glycemic control before and after COVID-19-related lockdown. Method(s): The Pediatric Quality of Life InventoryTM 3.0 Diabetes Module (PedsQLTM 3.0 DM) was used to evaluate the D-HRQOL. Patients who filled the D-HRQOL before lockdown (December 2019-February 2020;T0) were recruited in the study and filled the same survey immediately after the lockdown was stopped (June 2020;T1) during a routine outpatient or telemedicine visit. Data on diabetic ketoacidosis (DKA), severe hypoglycemic events, insulin therapy [dose and delivery method (MDI/CSII)], glucose monitoring method (SBGM/isCGM/rtCGM), glycosylate hemoglobin (HbA1c), physical activity (h/week), and SARS-CoV-2 infection were also collected. Continuous and categorical data are reported as median and percentage, respectively. Result(s): Sixty-two CYP (males 48.4%;age: 12.6 [5.25-17.8] years;T1D duration 4.23 [0.45- 16.4] years;MDI 71%;rtCGM 52%, SBGM 29%, and isCGM 19%;telemedicine visit 56.5%) with T1D and their parents (60 mothers, 10 fathers) were enrolled. Patients' and fathers' scales scores did not significantly change from T0 to T1. Mothers' 'Diabetes symptoms' scale score increased (67.0 vs. 70.4;p=0.007). According to visit type (outpatient vs. telemedicine), glucose monitoring (SBGM vs. isCGM vs. rtCGM), and insulin therapy (MDI vs. CSII), D-HRQOL data were longitudinally comparable and no differences was found between groups. During lockdown no DKA, severe hypoglycemic events, and SARS-CoV-2 were recorded in patients. Despite the significant decrease of exercise from T0 to T1 (3.25 vs. 0.50 h/week;p<0.0001), glycemic control (HbA1c 58.5 vs. 57.9 mmol/mol) and total daily insulin dose (0.86 vs. 0.82 IU/kg/day) were unchanged. At T1, the lower the HbA1c, the better patients' 'Diabetes symptoms' (R=-0.41, p<0.001), 'Worry' (R=-0.27, p=0.032) scales, and total scores (R=-0.33, p=0.009). Similar results were found in parents. Conclusion(s): During COVID-19 pandemic-related lockdown the D-HRQOL did not change in CYP with T1D and their parents. During visits we stressed the importance to keep a balanced nutritional program, according to new time spent on exercise, making diabetes managements easier and allowing the maintenance of good glycemic control without acute complications.
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Introduction: COVID-19 pandemic, by restricting outside activities, encouraged a sedentary lifestyle due to social distancing and, alongside, an increase in the consumption of canned food and industrialized foods, resulting in a negative impact on the growth of children and young people (CYP). Concerns for consequences in CYP with type 1 diabetes (T1D) rose. Objective(s): To investigate 1-year effects of the COVID-19 pandemic on auxological parameters and metabolic control in CYP with T1D. Method(s): Anthropometric [BMI (SDS), waist circumference/ height (WHt) ratio] and glycemic control data of CYP with T1D were collected during the annual routine outpatient visit between December 2020-February 2021 (T1, 1-year after the pandemic) and were compared with the ones of the same period in 2019-20 (T0, before lockdown). Data on number of visit (outpatient and telemedicine), diabetic ketoacidosis (DKA) and severe hypoglycemic events, insulin dose (IU/kg/day), glucose monitoring (SBGM/ isCGM/rtCGM), glycosylate hemoglobin (HbA1c), physical activity (h/week), and SARS-CoV-2 infection were collected. Result(s): Seventy-eight CYP with T1D (males 61.5%;age 13.7 [5.7-17.8] years;T1D duration 5.96 [2.1-15.4] years) were enrolled. The interval between visits was 1.06 years. Clinical and average annual HbA1c data at T1 were comparable to T0 (see Table). Physical activity decreased, while insulin TDD increased. The prevalence of patients with last HbA1c value <=53 mmol/mol increased (24 vs 28%, p<0.0001). The SARS-CoV-2 infection was recorded in 12 patients (15.4%). At T1, CGM use increased (67.9 vs 71.8%, p<0.001). The telemedicine visits increased because 56.4% of patients had at least one telemedicine. Rate of secondary DKA remained comparable and no severe hypoglycemic event was recorder. Conclusion(s): In our patients with T1D, both the BMI z-score and the glycemic control were maintained during the 1-year COVID-19 pandemic period, despite the decrease of regular physical activity. Our data may be possibly related to the increase of telemedicine visits that allowed us to adjust patients' insulin TDD, to avoid acute complications, and also to continue educational training to start CGM, complying with safety rules to avoid COVID-19 spread.
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Introduction: Since the beginning of the coronavirus disease 2019, (COVID-19) pandemic concerns for consequences on auxological data and glycemic control in patients with type 1 diabetes (T1D) were raised. Objective(s): To investigate the 2-years effects of the COVID-19 pandemic on body mass index (BMI) and glycemic control in children and adolescents with T1D. Method(s): Data on type and number of annual visit, auxological parameters [height (Ht), weight, and waist circumference (W)], insulin total daily dose (TDD), glycemic control (HbA1c), and weekly physical activity were collected during the annual routine outpatient visit between Dec 2021-Feb 2022 (T2) and were compared with those during the same period in 2019-20 (T0;before lockdown) and in 2020-21 (T1). Result(s): A 83 children and adolescents with T1D [65% male;median age 14.3 years (range 6.3-18.5);T1D duration 7.09 years (range 2.9-16.3)] were enrolled. The annual number of outpatient visits decreased (4 vs. 3 vs. 3;chi2 = 74.2;p < 0.0001), while frequency of patient using telemedicine increased (0 vs. 55.4 vs. 33.7%;chi2 = 48.1;p < 0.0001). BMI z-score significantly changed between periods, remaining within normal range values (0.19 vs. 0.08 vs. 0.23 SDS;chi2 = 15.9;p < 0.001). Height and WHt ratio were comparable. Physical activity was significantly different between periods (4 vs. 0 vs. 5 h/week;chi2 = 128.4;p < 0.0001) as well as insulin TDD (0.84 vs. 0.92 vs. 0.92 IU/kg/day;chi2 = 8.19;p = 0.017). Average of annual HbA1c values significantly improved (62.1 vs. 60.5 vs. 60.6 mmol/mol;X2 = 12.8;p = 0.002). Rate of secondary DKA remained comparable and no severe hypoglycemic event was recorder during follow-up. Conclusion(s): In our patients, BMI z-score was unchanged and glycemic control remained improved in the 2-years after COVID-19 pandemic spread. Our data may be possibly related to both the resuming of regular exercise and the increased use of sensor during T1 that allowed to continue with telemedicine visits in T2, adjusting patients' insulin TDD and avoiding acute complications.
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Introduction: In youths with type 1 diabetes (T1D), diabetic ketoacidosis (DKA) at onset increased during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In adults, diabetes was identified as risk factor for severe symptoms and hospitalization with the coronavirus disease-2019 (COVID-19) Objectives: To investigate the prevalence of SARS-CoV-2 infection and clinical characteristics of COVID-19 in children and adolescents with T1D Methods: SARS-CoV-2 infection was defined according to selfreported SARS-CoV-2 nasal swab PCR results (n=210) during the pandemic and seroprevalence of SARS-CoV-2 antibodies (n=85) from Jan to Jun-21. SARS-CoV-2 IgG were assessed using a chemiluminescent immunoassay (CLIA). Clinical characteristics and glycemic control data were collected before (T0) and 3-months after (T1) infection Results: SARS-CoV-2 infection was detected in 39 patients [24 males;median age 13.5 yrs (4.74-19.8);T1D duration 5.49 yrs (0.27-12.6)]: 26 (66.6%) based on positive nasal swab PCR and 13 (33.4%) on positive SARS-CoV-2 IgG. Patients detected by CLIA were asymptomatic. Four patients detected by nasal swab PCR were asymptomatic (15.4%), while the others reported ≥1 symptoms lasting a median of 5 days: fever (46.1%), headache (28.2%), anosmia and/or ageusia (25.6%), nasal congestion (15.4%), fatigue/myalgia (10.2%). Dry cough, pharyngeal erythema, nausea/vomiting, diarrhea, abdominal pain, arthralgia were reported by 2.56%. Glycemic control was not impaired from T0 to T1 (median HbA1c 58.5 vs 57.4 mmol/mol;TIR 58.5 vs 56.5%). Hospitalization and DKA were not recorded Conclusions: Using seroprevalence of antibodies we found an increased prevalence of SARS-CoV-2 infection that had no impact on glycemic control and acute complications. Asymptomatic subjects were 43%, while fever, headache, anosmia/ageusia were the most common clinical characteristics. Our data suggest that serological assay is useful to diagnosing previous SARS-CoV-2 infection and could be used to reconstruct the disease prevalence.
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Introduction: Since the beginning of the COVID-19 pandemic, concerns for consequences in patients with type 1 diabetes (T1D) were raised. Objectives: To compare the diabetes-specific health-related quality of life (D-HRQOL) of youths with T1D and their parents before and after the COVID-19-related lockdown. Methods: The Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 DM) was used to evaluate the D-HRQOL. Patients who filled the D-HRQOL before lockdown (Dec-19-Feb-20;T0) were recruited in the study and filled the same survey immediately after the lockdown was stopped (Jun-20;T1) during a routine outpatient or telemedicine visit. Results: Sixty-two patients (median age: 12.6 [5.25-17.8] yrs;T1D duration 4.23 [0.45- 16.4] yrs) with T1D and their parents (60 mothers, 10 fathers) were enrolled. Patients' scales scores did not significantly change from T0 to T1. Mothers significantly increased their Diabetes symptoms scale score (median 67.0 vs. 70.4;p=0.007). Data were also analyzed according to visit type (outpatient vs. telemedicine), glucose monitoring (SBGM vs. isCGM vs. rtCGM), and insulin therapy (MDI vs. CSII), but D-HRQOL data were longitudinally comparable and no difference was found between groups. During lockdown no DKA, severe hypoglycemic events, and SARS-CoV-2 were recorded. Despite the significant decrease of exercise (median 3.25 vs. 0.50 h/week;p<0.0001), median glycemic control (HbA1c 58.5 vs. 57.9 mmol/mol) and total daily insulin dose (0.86 vs. 0.82 IU/kg/day) were unchanged. At T1, the lower the HbA1c, the better patients' Diabetes symptoms (R=-0.41, p<0.001), Worry (R=-0.27, p=0.032) scales, and total scores (R=-0.33, p=0.009). Similar results were found in parents. Conclusions: During COVID-19 pandemic-related lockdown the D-HRQOL did not change in children and adolescents with T1D and their parents. Our data may be possibly related to staying at home, making diabetes managements easier and also allowing the maintenance of good glycemic control without acute complications.
ABSTRACT
Introduction: Since the beginning of the SARS-CoV-2 infection, concerns for consequences on auxological and glycemic control data in patients with type 1 diabetes (T1D) were raised. Objectives: To investigate 1-year effects of the COVID-19 pandemic on auxological parameters and metabolic control in youths with T1D. Methods: Anthropometric (height [Ht], weight, waist circumference [W]) and glycemic control data of patients with T1D were collected during the annual routine outpatient visit between Dec20-Feb21 (1-year after the pandemic) and were compared with the ones of the same period in 2019-20 (before the closure of schools and organized sport activities). Results: Seventy-eight children and adolescents with T1D (61.5% male;median age 13.7 [5.7-17.8] years;T1D duration 5.96 [2.1-15.4] years) were enrolled. Patients affected by SARS-CoV-2 infection were 15.4% (second wave). In Dec20-Feb21, BMI SDS and WHt ratio remained comparable to the year before lockdown. CGM use increased during the pandemic period (67.9 vs 71.8%, p<0.0001). Annual number of outpatient visits decreased (4 vs 3, p<0.0001), while telemedicine increased because 56.4% of patients had at least one telemedicine visit during pandemic (none before). Rate of DKA remained comparable (1.82 vs 2.56%) and no severe hypoglycemic event was recorder during pandemic (2.56 vs. 0%). Physical activity decreased (2 vs 0 h/week, p<0.001) and insulin TDD increased (0.84 vs 0.94 IU/kg/day, p=0.029). Average annual HbA1c values were comparable (62 vs 60 mmol/mol) and prevalence of patients with the last HbA1c value ≤53 mmol/mol increased (24 vs 28%, p<0.0001). Conclusions: In our patients with T1D, BMI SDS and glycemic control were maintained during the 1-year pandemic period despite the decrease of physical activity. Our data may be possibly related to the increase of telemedicine visits that allowed us to adjust patients' insulin TDD, to avoid acute complications, and also to continue educational training to start CGM, complying with safety rules to avoid COVID-19 spread.