ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Objectives. To investigate the safety and efficacy of SARS-Cov-2 vaccination in a large international cohort of patients with primary Sjogren syndrome due to scarcity of data in this population. Methods. By the first week of May 2021, all Big Data Sjogren Consortium centers had been contacted and asked for Registry patients to be included in the study if they had received at least one dose of any SARS-CoV-2 vaccine. The in-charge physician asked patients about local and systemic reactogenicity, using a pre-defined electronic questionnaire to collect epidemiologic data, COVID 19 vaccination data, and COVID 19 vaccination side effects. Adverse events were defined as those reported by the patient at the site of injection within 7 days from vaccination (reactogenicity) as local adverse events, systemic symptoms as systemic side effects, and postvaccination AEs of special interest related to SS as SS flares. Results. The vaccination data of 1237 patients (1170 women, with a mean age at diagnosis of primary SjS of 50.5 13.2) were received. A total of 835 patients (67 percent) reported any adverse event, including local (53 percent) and systemic (50 percent) AEs. Subjective symptoms (63%) were the most common local AEs, followed by objective signs at the injection site (16%) and general symptoms were the most commonly reported systemic AEs (46 percent), followed by musculoskeletal (25 percent), gastrointestinal (9 percent), cardiopulmonary (3 percent), and neurological (2 percent). People under 60 years old had a higher risk of developing AE after vaccination (OR 2.48, CI 95 1.89-3.27 percent), as did those with low systemic SS activity (OR 1.62, CI 95 1.22-2.15) and those who received mRNA vaccines, according to a multivariate analysis (OR 1.57, CI 95 percent 1.12- 2.18). The risk of developing systemic AEs was also higher in women (OR 2.85, CI 95 percent 1.60-5.2346), White people (OR 1.73, CI 95 1.14-2.65), and those who received a deficient vaccination regimen (OR 1.78, CI 95 1.12-2.88 percent). In addition to 141 (11%) patients who reported a significant worsening/exacerbation of their pre-vaccination sicca symptoms as a result of post-vaccination SS flares, 15 (1.2%) patients (13 women, mean age at vaccination 41.9 years) reported active involvement in the glandular (n=8), articular (n=7), cutaneous (n=6), pulmonary (n=2), and peripheral nervous system (n=1) domains as post-vaccination systemic flare. All side effects and flares subsided within 1-3 weeks, with no lasting effects or deaths. In terms of vaccination efficacy, breakthrough SARS-CoV-2 infection was confirmed after vaccination in three (0.24 percent) patients, all of whom recovered completely, and positive anti-SARS-Cov-2 antibodies were detected in approximately 95 percent of vaccinated SjS patients, according to data available. Conclusions. SARS-CoV-2 vaccination in patients with primary SjS, like other vaccines with adequate response and no safety signals, raised no concerns about the vaccine's efficacy or safety.
ABSTRACT
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.
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.