ABSTRACT
Background: The first COVID-19 case was reported in Kuwait in February 2020, and the pandemic rapidly spread in the country. To better understand the impact of COVID-19 on children, a pediatric registry was established, recording all cases of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in children, focusing on disease presentation, complications, severity of the disease and early outcomes. Methods: A retrospective, national-level, cohort study was performed and included all children aged ≤ 12 years with a confirmed SARS-CoV2 infection by polymerase chain reaction (PCR) in Kuwait between February 24th to December 31st, 2020. Cases were identified through reviewing national electronic SARS-CoV-2 testing, hospital admission records, and medical transfer services. During the study period infected children were identified through symptomatic testing, contact tracing, routine screening upon hospitalization, and screening before and after travel. Children who were older than 12 years at the time of sample collection or had equivocal RT-PCR result were excluded. Also, patients who had positive SARS-CoV-2 specific antibodies without documentation of positive SARS-CoV-2 RT-PCR were excluded in the analysis. Patient demographics, medical history, SARS-CoV-2 testing, signs and symptoms, therapeutic and medical intervention, complications, laboratory tests and outcome were obtained using The Kuwait Pediatric COVID-19 Registry (PCR-Q8). Descriptive analysis was performed. Results: During the study period, a total of 14,322 children aged ≤12 were diagnosed with SARS-CoV-2 infection in Kuwait. The first pediatric case was reported in March 2020. The monthly number of cases peaked during the summer of 2020 (July-September), and this was followed by a rapid decline during the beginning of winter of 2020 (figure 1). The median age was 7.6 years (IQR 4.1- 10.5) and half were male. Less than one-third (29.4%) were symptomatic (table 1). The number of children with pre-existing comorbidities was 228 (1.59%);the most common comorbidities were asthma (54, 0.37%), chronic neurological disorder (29, 0.2%) and acquired/congenital heart disease (25, 0.17%). The number of hospitalized children was 1599 (11.2%). The most common symptoms of those who were hospitalized were fever (39.8%), cough (17.6%), runny nose (11.1%) and diarrhea (8.4%). A total of 32 children were admitted to intensive care (0.22%), and 5 deaths were recorded (0.035%). Conclusion: Overall, the pediatric COVID-19 registry has invaluable information about the effect of COVID-19 on children in Kuwait. Such information can guide clinical practices for better understanding and management of COVID-19 in children.
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 coronavirus disease 2019 (COVID-19) affected countless peoples' lives including pediatric patients with type 1 diabetes. Dasman Diabetes Institute, as a specialized diabetes center, collected routine patient clinical data from 2018 to date to improve quality of care and optimize outcomes. Objectives: We aim to investigate the impact of COVID-19 on glycemic control, diabetic ketoacidosis (DKA) occurrences, and diabetes management. Methods: Body mass index (BMI), blood pressure (BP), hemoglobin A1C (HbA1c), DKA and insulin treatment modality were analyzed in 152, 154 and 53 pediatric patients aged <18 years from March to December in the pre-pandemic years 2018, 2019 and during the pandemic in 2020. In March 2020, a nation-wide total lockdown was implemented. Glycemic control was defined as an HbA1c <7%. DKA occurrence was self-reported in the past 12 months. Chi-squared test for trend was used to assess differences between the years. Results: Most patients in 2018 (99.3%) and 2019 (99.3%) had at least 1 value of HbA1c, BP and BMI recorded, however in 2020, only 32.1% had at least 1 value of HbA1c and BMI and none had BP recorded (p<0.0001). Glycemic control was found in 15.8%,12% and 7.7% of the patients consulted in 2018, 2019 and 2020, respectively. DKA occurred in 6.5%, 3.2% and 5.7% of the patients in those years too. Of the 112 clinic visits in 2020, 99 (88.4%) were virtual consultations. Over time, pump use was 44.7%, 48.7% and 54.7% and continuous glucose monitoring remained the same in 21.1%, 20.8% and 20.8% of the study population from 2018-2020. Conclusions: COVID-19 interrupted access to care due to nation-wide lockdowns and curfews which led to a decrease in patient follow up and poor data monitoring. Despite the decrease in patient follow-up, markers of care were not different before and during COVID-19. The steep decrease in follow-up and lack of difference in quality of care could potentially be due to patients seeking medical care elsewhere. (Table Presented).