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Pediatric Diabetes ; 22(SUPPL 30):38, 2021.
Article in English | EMBASE | ID: covidwho-1571005


Introduction: From March to May 2020, Portugal was under the first COVID-19 lockdown, which has brought considerable changes to people's lifestyles. Objectives: To evaluate lockdown impact on glycaemic control in children and adolescents with T1D, and identify its potentially related factors. Methods: An observational study based on an anonymous questionnaire sent by email to the families with children and adolescents with T1D living in Portugal. Collected variables: demographics, age at onset, insulin treatment, glycaemic control, lifestyle, mental health, SARS-CoV-2 infection, contact with the diabetes team. Data before, during, and after the lockdown was compared. Results: We enrolled 337 subjects, 50% males, with a median age of 13(2-19)y, and a median T1D duration of 5(0-17)y. 87% were on CSII, and 84% had CGM (42% with real-time connection to the caregivers). Before lockdown, median daily exercise was 1(0-4)h, median HbA1c was 7.4(5.2-14.8)%, and median TIR was 60(20-93)%. From March to May 2020, physical activity decreased [Δ -0.5(-3 to 2) h/day;p=0.01], 50.9% of subjects put on weight, and 75.3% needed a rise in total daily insulin. There were 16 cases of metabolic decompensation, mainly for pump failure or insulin omission. When compared to the previous period, there were no differences in median HbA1c [Δ 0 (-5.5 to 3.4)%] or median TIR [Δ -2(-24 to 25)%]. From the 32 SARSCoV- 2 positive cases, 11 had difficulties controlling hyperglycaemia, but only 2 needed hospitalization. In 2020, the median number of appointments per subject was 4(0-10), 30% of which by telemedicine. Only 22.4% of families perceived lockdown as a period of glycaemic deterioration. Conclusions: Glycaemic control did not worsen in our children and adolescents with T1D across the COVID-19 pandemic. Despite being confined at home with scarce exercise and weight increase, the fear of possible higher infection risk, along with family T1D knowledge and supervision, home meals, and telemedicine might have been relevant factors to this shaky balance.

Pediatric Diabetes ; 22(SUPPL 30):86-87, 2021.
Article in English | EMBASE | ID: covidwho-1570994


Introduction: The rate of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus (T1D) is multifactorial. There seems to be an inverse relationship between T1D's incidence and DKA's frequency. DKA has been reported to be more common among young children. Recently, the COVID-19 pandemic has posed additional challenges as to diagnosing T1D. Objectives: We aimed to assess the rate of DKA and associated risk factors in pediatric new-onset T1D in a large pediatric diabetes center in Portugal. Methods: Retrospective analysis of data of patients referred to a level III pediatric hospital between January 1st, 2013 and December 31th, 2020 (8 years). Results: We included 276 children and adolescents with a median age of 9,6 years, 20,1% under 5 years old. A mean incidence of 35 new cases/year was observed, with an upward trend. Newonset T1D cases under 5 years old raised progressively, having more than tripled throughout the study period (n=3 in 2013 vs. n=10 in 2020). In total, 38% children and adolescents presented with DKA, ranging from 23,3% in 2013 to 43,2% in 2020, while remaining stable (37,2%-40,9%) in the period in-between. Overall, DKA was considered severe in 24,8% of cases, ranging from 6% in 2017 to 47% in 2020. 20 (7,2%) patients were admitted to the intensive care unit. DKA at presentation was more frequent in the age group under 2 years old (p=0,016), in which 80% of patients presented with DKA. Non-DKA presentation was associated with family history of T1D (p=0,005). Conclusions: Our study shows an upward trend in T1D's incidence in children under 5 years old and a high DKA rate at disease onset, which was more frequent in patients under 2 years of age. In the first year of COVID-19 pandemic, 43% of DKA was considered severe. It is urgent to implement educational programs to promote earlier diagnosis. Broader studies are required to provide a representative national landscape of the epidemiology of T1D in pediatric population in Portugal.

Pediatric Diabetes ; 22(SUPPL 30):49, 2021.
Article in English | EMBASE | ID: covidwho-1570993


Introduction: On 12th March 2020, a national lockdown was imposed in Portugal, as a response to rising COVID-19 cases. Since then healthcare access patterns were deeply modified. Objectives: In this study, we tried to understand what shifted from prior years in new-onset type 1 diabetes mellitus (T1D). Methods: It was performed a retrospective analysis of patients referred to a level III pediatric hospital from March 2020 until March 2021. Patients admitted during the same period in the 3 previous years were set as control group. Results: Since lockdown imposition, 44 children and adolescents were diagnosed T1D, contrasting with prior mean incidence of 32 cases/ year. Median age was 9,9 years (min. 0,5 - max. 15,8). Children under 2 years-old represented 4,9% of cases, contrasting with only 2,1% in previous years. All subjects were tested for SARS CoV-2 but only 2 were positive. When comparing to prior years, subjects presenting with less than one week of symptoms almost doubled in 2020, (19,5% vs. 10,4%), and a higher rate of diabetic ketoacidosis (DKA) was also observed (53,7%, vs. 38,5%). DKA severity was also higher (40,9% vs. 21,6%;p=0,02 and 14,6% subjects required admission to intensive care unit. Conclusions: Similarly to other reports, a higher number of new-onset T1D was observed, with a comparable increase in severity. In contrast to what might have been expected, DKA prevalence and severity was not necessarily linked to delayed diagnosis. We estimate that such severity may be related to a higher proportion of younger patients. While the role of SARS CoV-2 exposure in pancreatic islet cells destruction is still under investigation, antibody assessment and detailed contact history could help to explain the increased prevalence and severity of new-onset T1D during the pandemic period.