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1.
BMJ Case Rep ; 15(1)2022 Jan 18.
Article in English | MEDLINE | ID: covidwho-1634417

ABSTRACT

Delayed diagnosis, low socioeconomic status and infection have been associated with diabetic ketoacidosis (DKA) at type 1 diabetes mellitus presentation. A teenager from a low socioeconomic status family, with longstanding weight loss, polyphagia, polyuria, vomiting and abdominal pain, attended the emergency department, also complaining of anosmia and odynophagia. He was diagnosed with COVID-19 and new-onset DKA. The second child had 2 weeks of diabetes symptoms and was admitted with new-onset mild DKA. SARS-CoV-2 RT-PCR test was positive, although asymptomatic. Persistent hyperglycaemia with high insulin requirements was a common feature to both patients. Both cases support that SARS-CoV-2 may have an association with rapidly increasing insulin daily needs. In case one, not only fear of COVID-19 delayed hospital attendance but also the setting of a low socioeconomic status family appears to have enhanced the risk for late diagnosis and challenging disease management.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Adolescent , Child , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/diagnosis , Humans , Insulin , Male , SARS-CoV-2
2.
Am J Case Rep ; 22: e933879, 2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1574779

ABSTRACT

BACKGROUND Wounds affect millions of people world-wide, with care being costly and difficult to deliver remotely. The ongoing COVID-19 pandemic highlights the urgent need for telehealth solutions to play a larger role as part of remote care strategies for patient monitoring and care. We describe our findings on the use of a patient-facing wound care app (Swift Patient Connect App, Swift Medical, Canada) as an innovative solution in remote wound assessment and management of a diabetic patient's wound. CASE REPORT In February 2020, a 57-year-old man with type I diabetes and peripheral arterial disease presented with osteomyelitis in the left foot at the fifth metatarsal, arising from a chronic ulcer. The wound was deep, with purulent discharge and polymicrobial growth. A 6-week course of intravenous antibiotics was administered, with slow improvement of the wound. At a follow-up appointment in June 2020, The Patient Connect app was recommended to the patient to securely share calibrated images of his wound as well to communicate with his doctor. Between June 2020 and January 2021, wound closure was accurately monitored as part of the management of this diabetic foot infection. The app was also used in the management of 2 subsequent wounds and infection episodes. CONCLUSIONS Use of the Swift Patient Connect App designed to monitor and manage wounds by a patient with diabetes and foot ulcer as part of a remote care strategy resulted in numerous benefits expressed by the patient. After initial adoption, 3 successive wounds were managed with a combination of in-person and telehealth visits complemented by the app. Incorporation of this technology as part of a novel telemedicine strategy promises to have an extensive impact on remote care delivery during the current COVID-19 pandemic and beyond.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Foot , Mobile Applications , Diabetes Mellitus, Type 1/complications , Diabetic Foot/therapy , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Smartphone
3.
Eur Rev Med Pharmacol Sci ; 25(19): 5928-5935, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1478934

ABSTRACT

OBJECTIVE: A positive relationship between the recently emerged Corona Virus Disease-19 (COVID-19) and diabetes has been inferred, but not confirmed, in children. The aim of the present study was to investigate the possible impact of COVID-19 on new-onset Type-1 Diabetes Mellitus (T1DM) in a pediatric population. PATIENTS AND METHODS: This is a prospective study of all children and adolescents diagnosed with T1DM during the first year of the COVID-19 pandemic (March 2020-February 2021) in Western Greece (population coverage ≈1,000,000). The incidence and severity of T1DM, the age and sex of the participants and HbA1c and c-peptide concentrations at diagnosis were recorded and compared to those of the previous year (pre-COVID-19 year). RESULTS: 21 children aged 8.03±0.90 years old were diagnosed with T1DM in the COVID-19 year and 17, aged 9.44±3.72 years old, in the pre-COVID-19 year. A different seasonality pattern of new onsets was observed during the COVID-19 year compared to the previous year, with increasing trend from spring to winter (spring: 9.5% vs. 23.5%, autumn: 23.8% vs. 29.4%, summer: 19% vs. 11.8%, winter: 47.6% vs. 35.3%). Also, compared to the preceding year, HbA1c was significantly higher (p=0.012) and the incidence and severity of diabetic ketoacidosis greater (p=0.045, p=0.013, respectively). CONCLUSIONS: This is the first study to report a different seasonality pattern and increased severity of new-onset T1DM during the first year of the COVID-19 pandemic. Future research should further investigate the possible role of SARS-CoV-2 and the different pattern of overall infection incidence during the COVID-19 year.


Subject(s)
COVID-19/complications , Diabetes Mellitus, Type 1/complications , Adolescent , C-Peptide/analysis , COVID-19/epidemiology , Child , Child, Preschool , Diabetes Mellitus, Type 1/epidemiology , Diabetic Ketoacidosis/epidemiology , Female , Glycated Hemoglobin A/analysis , Greece/epidemiology , Humans , Incidence , Male , Prospective Studies , Seasons
4.
Metabolism ; 122: 154842, 2021 09.
Article in English | MEDLINE | ID: covidwho-1406306

ABSTRACT

BACKGROUND: COVID-19 pandemic caused families to stay home and cancel everyday activities. Hospital admissions decreased, affecting changes in diagnoses and management of chronic disease in children. AIMS: We analyzed how the first lockdown influenced clinical presentation and manifestation of children with diabetes mellitus (DM) in a German University Hospital. METHODS: During March 15th and October 11th 2020, data on general patient information, clinical symptoms and on lab results related to diabetic ketoacidosis (DKA) were analyzed in children (0-18 years) who presented with new onset of DM or poor metabolic control of known DM. All data including frequency and severity of DKA were compared to data from patients who presented in 2019. RESULTS: Data from 125 participants with DM were evaluated (2020: n = 52; 2019: n = 73). In 2020, twelve patients (23.1%) were diagnosed with new onset DM, two of them with type2 diabetes, and 66.7% presented with DKA including both patients T2DM. In 2019, 24.5% of patients had new onset DM, and 50% of them presented with DKA. In 2020, patients with new onset DM were younger, presented with more severe symptoms of DKA and had to stay longer in hospital compared to 2019. In 2020, six children (50%) with new onset DM were <6 years, whereas in 2019 most children with new onset DM were adolescents (n = 7, 38.9%). CONCLUSION: COVID-19 lockdown aggravated complications of diabetes onset and therapy management, including severity and frequency of DKA. It underlines the need of health education for early DKA diagnosis to early identify children at risk.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Diabetic Ketoacidosis/complications , Pandemics , Adolescent , Adult , COVID-19/complications , Child , Female , Humans , Male , Young Adult
6.
Nutr Diabetes ; 11(1): 21, 2021 06 23.
Article in English | MEDLINE | ID: covidwho-1281687

ABSTRACT

The advent and rapid spread of the coronavirus disease-2019 (COVID19) pandemic across the world has focused attention on the relationship of commonly occurring comorbidities such as diabetes on the course and outcomes of this infection. While diabetes does not seem to be associated with an increased risk of COVID19 infection per se, it has been clearly demonstrated that the presence of hyperglycemia of any degree predisposes to worse outcomes, such as more severe respiratory involvement, ICU admissions, need for mechanical ventilation and mortality. Further, COVID19 infection has been associated with the development of new-onset hyperglycemia and diabetes, and worsening of glycemic control in pre-existing diabetes, due to direct pancreatic damage by the virus, body's stress response to infection (including cytokine storm) and use of diabetogenic drugs such as corticosteroids in the treatment of severe COVID19. In addition, public health measures taken to flatten the pandemic curve (such as lockdowns) can also adversely impact persons with diabetes by limiting their access to clinical care, healthy diet, and opportunities to exercise. Most antidiabetic medications can continue to be used in patients with mild COVID19 but switching over to insulin is preferred in severe disease.


Subject(s)
COVID-19/complications , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Blood Glucose , COVID-19/blood , Communicable Disease Control , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 2/blood , Humans , Pandemics
7.
Metabolism ; 121: 154814, 2021 08.
Article in English | MEDLINE | ID: covidwho-1265810

ABSTRACT

Diabetes, one of the most prevalent chronic diseases in the world, is strongly associated with a poor prognosis in COVID-19. Scrupulous blood sugar management is crucial, since the worse outcomes are closely associated with higher blood sugar levels in COVID-19 infection. Although recent observational studies showed that insulin was associated with mortality, it should not deter insulin use in hospitalized patients requiring tight glucose control. Back and forth dilemma in the past with regards to continue/discontinue certain medications used in diabetes have been mostly resolved. The initial fears of consequences related to continuing certain medications have been largely dispelled. COVID-19 also necessitates the transformation in diabetes care through the integration of technologies. Recent advances in health-related technologies, notably telemedicine and remote continuous glucose monitoring, have become essential in the management of diabetes during the pandemic. Today, these technologies have changed the landscape of medicine and become more important than ever. Being a high-risk population, patients with type 1 or type 2 diabetes, should be prioritized for vaccination. In the future, as the pandemic fades, the prevalence of non-communicable diseases is expected to rise due to lifestyle changes and medical issues/dilemma encountered during the pandemic.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Blood Glucose/metabolism , Blood Glucose Self-Monitoring , COVID-19/complications , COVID-19/epidemiology , COVID-19/mortality , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Disease Susceptibility , Humans , Hypoglycemic Agents/therapeutic use , Pandemics , SARS-CoV-2/isolation & purification
8.
J Investig Med High Impact Case Rep ; 9: 23247096211021231, 2021.
Article in English | MEDLINE | ID: covidwho-1259169

ABSTRACT

We report 11 cases of combined diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNK) in coronavirus 2019 patients who presented to our institution in New Jersey, USA. The median age was 47 years (range 12-88 years). Out of the 11 patients, 7 were male and 4 were female. Out of 11 patients, 8 had type 2 diabetes mellitus (DM), 2 had undiagnosed DM, and 1 had type 1 DM. Presenting complaints included altered mental status, weakness, shortness of breath, cough, fever, vomiting, abdominal pain, chest pain, and foot pain. Out of 11 patients, pneumonia was diagnosed at presentation in 8 patients, while in 3 patients, chest X-ray was clear. Median value of initial glucose on presentation was 974 mg/dL (range 549-1556 mg/dL), and hemoglobin A1c on presentation was 13.8%. The median value of anion gap was 34 mEq/L. Out of the 11 patients, ketonemia was moderate in 6 patients, large in 3, and small in 2 patients. Acute kidney injury (AKI) occurred in 9 patients and 2 patients required renal replacement therapy. Out of the 11 patients, 6 required mechanical ventilation and 7 patients died. All the 6 patients requiring mechanical ventilation died. Our case series shows COVID-19 infection can precipitate acute metabolic complications in known DM patients or as first manifestation in undiagnosed DM patients. Patients can present with DKA/HHNK symptoms and/or respiratory symptoms. Mechanical ventilation is a poor prognostic factor. Further studies are needed to characterize prognostic factors associated with mortality in this vulnerable patient population.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/complications , Hyperglycemic Hyperosmolar Nonketotic Coma/complications , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/therapy , Child , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Female , Humans , Male , Middle Aged , Renal Replacement Therapy , Respiration, Artificial , SARS-CoV-2 , Treatment Outcome , Young Adult
9.
Ital J Pediatr ; 47(1): 121, 2021 Jun 02.
Article in English | MEDLINE | ID: covidwho-1255953

ABSTRACT

BACKGROUND: Cystic Fibrosis Related Diabetes (CFRD) is a frequent comorbidity of patients with Cystic Fibrosis (CF). A worsening of clinical conditions appears before CFRD. It has been demonstrated a decline in pulmonary function and nutritional status also in patients with prediabetes. Few trials show that insulin may be beneficial in prediabetic CF patients, to date guidelines do not recommend for this condition. CASE PRESENTATION: We report a case of a patient treated with insulin glargine at 13 years, due to glycemic intolerance, and with Lumacaftor/Ivacaftor at 15 years. A reduction of pulmonary exacerbations was observed after glargine therapy, also confirmed after the starting of Lumacaftor/ Ivacaftor in this patient. Pulmonary function improved only after the first year of glargine therapy, then a deterioration appeared due to the natural history of CF lung damage. During the COVID-19 lockdown, poor adherence to care contributed to diabetes mellitus onset needing high insulin requirements. After two weeks the patient returned to prediabetic condition and his previous dose of glargine. CONCLUSIONS: our case highlights firstly that insulin glargine has contributed to preserve him from further clinical worsening due to prediabetes in the years before pandemic, secondly the negative impact of COVID-19 lockdown on the clinical course of a chronic disease as CF.


Subject(s)
COVID-19/epidemiology , Cystic Fibrosis/complications , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin Glargine/therapeutic use , Adolescent , Cystic Fibrosis/physiopathology , Humans , Male , Pandemics , Prediabetic State , Respiratory Function Tests , SARS-CoV-2
10.
Adv Ther ; 38(6): 3314-3324, 2021 06.
Article in English | MEDLINE | ID: covidwho-1252245

ABSTRACT

INTRODUCTION: Diabetic ketoacidosis (DKA) is an acute complication associated with poorly managed or undiagnosed diabetes. DKA is associated with significant morbidity, mortality, and healthcare costs, but can be prevented with appropriate management of diabetes. The FreeStyle Libre is flash glucose monitoring device that measures glucose levels in the interstitial subcutaneous tissue and has been shown to reduce HbA1c, time in hypoglycemia and hyperglycemia, as well as improve health-related quality of life. METHODS: A retrospective chart review of patients with type 1 diabetes mellitus (T1DM) and recurrent DKA and who initiated FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) was conducted. DKA frequency and severity, glycated hemoglobin (HbA1c), and frequency of blood glucose monitoring were compared between the 2-year period before FreeStyle Libre initiation and the 2-year period after FreeStyle Libre initiation. RESULTS: A total of 47 patients with T1DM with recurrent DKA were included. FreeStyle Libre was associated with a reduction in the frequency of DKA events, with a mean of 0.2 (standard deviation [SD] 0.4) events per person during the 2 years after FreeStyle Libre initiation versus 2.9 (SD 0.9) during the 2 years before FreeStyle Libre initiation. Severity of DKA events was also reduced, with fewer severe (before mean 0.3 [SD 0.5] versus after 0.0 [SD 0.0]; p < 0.001) DKA events. A reduction in HbA1c (mean 7.4% [SD 0.5] after versus 9.9% [SD 1.2] before [p < 0.001]) and an increase in frequency of blood glucose testing (mean 8.1 scans/day [SD 1.7] after versus 2.2 finger-pricks/day [SD 0.7] at before [p < 0.001]) were also observed. CONCLUSION: FreeStyle Libre is associated with a reduction in the frequency and severity of DKA events, reduction in HbA1c, and increase in frequency of blood glucose testing in patients with T1DM and recurrent DKA. The use of such a glucose monitoring tool can help to reduce the burden of morbidity, mortality, and healthcare costs associated with complications of diabetes.


Subject(s)
Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Blood Glucose , Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Diabetic Ketoacidosis/epidemiology , Humans , Quality of Life , Retrospective Studies
12.
BMC Neurol ; 21(1): 202, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1236547

ABSTRACT

BACKGROUND: Spinal neuroarthropathy (SNA), also known as Charcot spine, is an uncommon aggressive arthropathy, secondary to loss of proprioceptive and nociceptive feedback from the spine. A diagnosis of SNA is frequently delayed due to the scarcity of symptoms in its early stages, leading to significant neurological deterioration. Therefore, prompt suspicion of the disease is critical to providing better outcomes. This case assembles two rare characteristics of SNA: diabetic aetiology and a precocious time of diagnosis, and aims to highlight the magnetic resonance imaging (MRI) findings that allowed for the diagnosis. CASE PRESENTATION: A 44-year-old woman, with long-term type 1 diabetes, presented with a two-month history of progressive lumbar pain, difficulty in maintaining an upright position, and discrete trunk forward-leaning. Diabetes-related vasculopathy and nephropathy were already known, and laboratory test results did not show any new abnormalities. A lumbar MRI revealed extensive signal intensity changes of the L2 and L3 vertebral bodies associated with marginal areas of enhancement and the involvement of regions adjacent to interapophyseal articulations and spinous processes from L2-L3 to L5-S1, in association with degenerative changes of the thoracolumbar spine. These findings were identified by the radiologist as suggestive of SNA. To rule out neoplastic and infectious disease, a bone biopsy at the L2-L3 level was executed. The pathology report revealed intervertebral disc material and fragments of fibrous tissue, with a complete absence of inflammatory cells. It was decided to perform a six-month MRI follow-up, which showed stability of the findings, confirming the hypothesis of Charcot spine. The patient was under clinical and radiological follow-up and did not require surgical fixation at the moment of diagnosis. After 2.5 years from the initial diagnosis, a new MRI revealed progression of the lesions with oedema and enlarged paravertebral soft tissues; these findings are compatible with the patient's latest complaints of lumbar pain recurrence. CONCLUSION: To the best of our knowledge, this is the first case report of an MRI-based early diagnosis of diabetic SNA, a rare disease with nonspecific symptoms in its initial stages and a wide spectrum of differential diagnoses. The MRI findings, distinctly the involvement of both anterior and posterior spinal elements, were the key to allowing for the proper diagnosis. A precocious diagnosis, although challenging, is fundamental to providing early intervention and to preventing further neurological impairment.


Subject(s)
Arthropathy, Neurogenic , Magnetic Resonance Imaging , Spinal Diseases/diagnostic imaging , Adult , Arthropathy, Neurogenic/diagnostic imaging , Arthropathy, Neurogenic/etiology , Diabetes Mellitus, Type 1/complications , Diagnosis, Differential , Female , Humans , Low Back Pain , Lumbar Vertebrae/diagnostic imaging
13.
Diabetologia ; 64(8): 1717-1724, 2021 08.
Article in English | MEDLINE | ID: covidwho-1219907

ABSTRACT

AIMS/HYPOTHESIS: The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. METHODS: A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. RESULTS: Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55-74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. CONCLUSIONS/INTERPRETATION: In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. IN PEOPLE WITH TYPE 1 DIABETES AND COVID-19 ADMITTED TO HOSPITAL IN THE UK, BMI AND ONE OR MORE MICROVASCULAR COMPLICATIONS HAD A POSITIVE ASSOCIATION AND LOW SERUM CREATINE LEVELS HAD A NEGATIVE ASSOCIATION WITH DEATH/ADMISSION TO INTENSIVE CARE UNIT AFTER ADJUSTING FOR AGE.


Subject(s)
COVID-19/epidemiology , COVID-19/pathology , Diabetes Mellitus, Type 1/epidemiology , Patient Admission/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/therapy , Female , Hospitals/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index , United Kingdom/epidemiology
14.
J Pediatr Endocrinol Metab ; 34(7): 925-936, 2021 Jul 27.
Article in English | MEDLINE | ID: covidwho-1197410

ABSTRACT

OBJECTIVES: COVID-19 pandemic significantly impacted the diagnosis of type 1 diabetes and its acute complications. Thus, the study aimed to evaluate the characteristics of pediatric patients with type 1 diabetes hospitalized during the first wave of the pandemic and the prevalence of new onset diabetes among patients with evidence of COVID-19 infection. METHODS: A single-center surveillance study included all patients with diabetes admitted to Children's Hospital, Ain Shams University, in Egypt between May to August 2020. Data were collected to evaluate patients' clinical and laboratory characteristics as well as their outcomes. RESULTS: Thirty-six patients were admitted during the study period. The mean age was 8.4 ± 3.8 years. Patients presented late to the emergency department with a mean delay of 3.05 ± 1.19 days from onset of symptoms. 34/36 patients presented in diabetic ketoacidosis (DKA), 50% presenting in severe DKA. Almost 81% of the patients were newly diagnosed. During the study period, SARS-CoV-2 PCR was found positive in four patients, COVID Ig M antibodies were positive in another two patients; all were symptomatic requiring ICU admission. Four patients showed a picture suggestive of the multi-inflammatory syndrome (MIS-C); cardiac affection was a constant feature. CONCLUSIONS: The pandemic affected both the prevalence and severity of DKA among pediatric patients. The increased prevalence of severe DKA could be partly related to delayed hospital admission or the effect of COVID-19 in triggering DKA. Efforts should be done to continuously raise awareness about diabetes in children as well as the importance of seeking timely medical guidance.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/epidemiology , SARS-CoV-2 , Adolescent , Child , Child, Hospitalized , Child, Preschool , Egypt/epidemiology , Female , Humans , Logistic Models , Male , Severity of Illness Index
16.
BMJ Case Rep ; 14(3)2021 Mar 25.
Article in English | MEDLINE | ID: covidwho-1186259

ABSTRACT

A 22-year-old woman with type Ia glycogen storage disease was referred to the endocrinology department with new-onset diabetes mellitus-glycated haemoglobin (HbA1c) of 8.2%. She had suffered from repeated bouts of hypoglycaemia since the first days of her life. The diagnosis was made at 5 months old, after clinical investigations revealed mixed dyslipidaemia, lactic acidosis and hepatomegaly. Compound heterozygosity was documented at the age of 4. The basis of her initial treatment was starch and reinforced soy milk, ingested multiple times a day and night. The patient suffered from obesity since childhood. This case shows a rare association between glycogen storage disease type Ia and diabetes mellitus. A multidisciplinary approach was implemented. Through diet and use of flash continuous glucose monitoring, we were able to improve patient's adherence and metabolic profile. Hypoglycaemia and hyperglycaemia risk significantly decreased; 86% time in range (70-180 mg/dL), 6% hypoglycaemia and 6.3% HbA1c in recent evaluations.


Subject(s)
Diabetes Mellitus, Type 1 , Hypoglycemia , Adult , Blood Glucose , Blood Glucose Self-Monitoring , Child , Diabetes Mellitus, Type 1/complications , Female , Glycated Hemoglobin A/analysis , Humans , Hypoglycemia/etiology , Infant , Young Adult
17.
J Diabetes ; 13(8): 681-687, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1186120

ABSTRACT

BACKGROUND: Diabetes is a risk factor for poor COVID-19 outcomes, but pediatric patients with type 1 diabetes are poorly represented in current studies. METHODS: T1D Exchange coordinated a US type 1 diabetes COVID-19 registry. Forty-six diabetes centers submitted pediatric cases for patients with laboratory confirmed COVID-19. Associations between clinical factors and hospitalization were tested with Fisher's Exact Test. Logistic regression was used to calculate odds ratios for hospitalization. RESULTS: Data from 266 patients with previously established type 1 diabetes aged <19 years with COVID-19 were reported. Diabetic ketoacidosis (DKA) was the most common adverse outcome (n = 44, 72% of hospitalized patients). There were four hospitalizations for severe hypoglycemia, three hospitalizations requiring respiratory support (one of whom was intubated and mechanically ventilated), one case of multisystem inflammatory syndrome in children, and 10 patients who were hospitalized for reasons unrelated to COVID-19 or diabetes. Hospitalized patients (n = 61) were more likely than nonhospitalized patients (n = 205) to have minority race/ethnicity (67% vs 39%, P < 0.001), public insurance (64% vs 41%, P < 0.001), higher A1c (11% [97 mmol/mol] vs 8.2% [66 mmol/mol], P < 0.001), and lower insulin pump and lower continuous glucose monitoring use (26% vs 54%, P < 0.001; 39% vs 75%, P < 0.001). Age and gender were not associated with risk of hospitalization. Higher A1c was significantly associated with hospitalization, with an odds ratio of 1.56 (1.34-1.84) after adjusting for age, gender, insurance, and race/ethnicity. CONCLUSIONS: Higher A1c remained the only predictor for hospitalization with COVID-19. Diabetic ketoacidosis is the primary concern among this group.


Subject(s)
COVID-19/complications , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/etiology , Glycated Hemoglobin A/metabolism , Hospitalization , Adolescent , Age Factors , Biomarkers/blood , COVID-19/diagnosis , COVID-19/virology , Child , Child, Preschool , Cross-Sectional Studies , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/diagnosis , Diabetic Ketoacidosis/blood , Diabetic Ketoacidosis/diagnosis , Disease Progression , Female , Humans , Infant , Infant, Newborn , Male , Registries , Risk Assessment , Risk Factors , United States , Up-Regulation
18.
Sci Rep ; 11(1): 6812, 2021 03 24.
Article in English | MEDLINE | ID: covidwho-1149747

ABSTRACT

This study aimed to assess the psychological impact of the COVID-19 pandemic on guardians of children and adolescents with type 1 diabetes. An online survey was performed to assess the prevalence of pandemic-related emotional burden, mental health disorders and diabetes-specific emotional burden related to diabetes care during the COVID-19 pandemic. Caregivers of children and adolescents with diabetes under the age of 18 and caregivers of youth without diabetes for the non-diabetes group were invited to participate. For the primary outcome, mental health disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20), while pandemic-related emotional burden and diabetes-specific emotional burden related to diabetes care were evaluated in different domains with specific questions. For analyses, a hierarchical testing strategy was performed. A total of 764 participants were included in the study. Regarding the pandemic period, caregivers of youth with type 1 diabetes endorsed significantly more pandemic-related emotional burden for both themselves (OR 1.67; 95% CI, 1.10 to 2.53) and for their child (OR 2.28; 95% CI, 1.54 to 3.38) when compared to the non-diabetes group. The emotional burden evaluation on different age ranges showed that the two groups were similar when the dependent youth was younger than 6 years. Moreover, a positive screening for mental health disorders during social distancing was higher in the diabetes group compared to the non-diabetes group (OR 2.43; 95% CI, 1.70 to 3.47), particularly in those aged under 12 years old. There was no difference between groups in mental health disorders among caregivers of adolescents older than 12 years. Our results allow to conclude that concern, burden and mental health disorders can be present in caregivers of youth with diabetes, and behavioral changes during the COVID-19 pandemic may enhance this situation.


Subject(s)
COVID-19/psychology , Caregivers/psychology , Adult , Anxiety/psychology , COVID-19/epidemiology , COVID-19/virology , Depression/psychology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/virology , Family , Female , Humans , Male , Mental Disorders/epidemiology , Mental Health , Middle Aged , Pandemics , Prevalence , SARS-CoV-2/isolation & purification , Surveys and Questionnaires
19.
Pediatr Endocrinol Diabetes Metab ; 26(4): 167-175, 2020.
Article in English | MEDLINE | ID: covidwho-1112834

ABSTRACT

INTRODUCTION: On March 11, 2020 the WHO announced a coronavirus disease 2019 (COVID-19) pandemic. Lockdown restrictions, compromised access to medical care and fear of potential exposure to SARS-CoV-2 have forced patients with non-COVID-19 illnesses such as type 1 diabetes (T1D) to stay home. This situation can lead to delay in T1D diagnosis and insulin treatment resulting in rapid progression to diabetic ketoacidosis (DKA) and therefore increased risk of complications and death.  . AIM: The aim of this study was to evaluate the frequency and severity of DKA at the onset of T1D in children diagnosed in our department during COVID-19 pandemic lockdown from March 2020 till May 2020 in comparison to corresponding period of the previous year. . MATERIAL AND METHODS: We collected data of children with newly diagnosed T1D. DKA was defined according to ISPAD guidelines. . RESULTS: The study cohort comprised 34 children in group 2020 and 52 in group 2019 with an average age 9.90 ±4.9 vs. 9.59±4.7 years with mean HbA1c 12.9 ±2.4 vs. 11.5 ±2.2%, respectively. The incidence of DKA was higher by 12% in group 2020 vs. 2019 (52.94% vs 40.38%; p = 0.276).  Regarding the DKA severity (2020 vs. 2019) 32.35% vs. 11.54% were severe (p = 0.026), 17.65 vs. 13% were moderate (p = 0.759), and 2.94 vs. 15.38% were mild (p = 0.081). None of the analyzed patients were COVID-19 positive. CONCLUSIONS: During the COVID-19 pandemic lockdown changes in society and health care system, the DKA rate has increased by 12 percentage points with more severe cases noted in children with newly diagnosed T1D. Regular education of the whole society about the symptoms of diabetes could contribute to faster diagnosis of T1D and reduction of DKA prevalence. .


Subject(s)
COVID-19/psychology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/etiology , Health Services Accessibility/statistics & numerical data , Quarantine/statistics & numerical data , Adolescent , COVID-19/epidemiology , Child , Child, Preschool , Cohort Studies , Diabetes Mellitus, Type 1/epidemiology , Diabetic Ketoacidosis/epidemiology , Female , Humans , Incidence , Male , Pandemics/statistics & numerical data , Poland/epidemiology , Prevalence , Quarantine/trends , Risk Factors , SARS-CoV-2
20.
Endocr Rev ; 41(3)2020 06 01.
Article in English | MEDLINE | ID: covidwho-1110054

ABSTRACT

Individuals with diabetes are at increased risk for bacterial, mycotic, parasitic, and viral infections. The severe acute respiratory syndrome (SARS)-CoV-2 (also referred to as COVID-19) coronavirus pandemic highlights the importance of understanding shared disease pathophysiology potentially informing therapeutic choices in individuals with type 2 diabetes (T2D). Two coronavirus receptor proteins, angiotensin-converting enzyme 2 (ACE2) and dipeptidyl peptidase-4 (DPP4) are also established transducers of metabolic signals and pathways regulating inflammation, renal and cardiovascular physiology, and glucose homeostasis. Moreover, glucose-lowering agents such as the DPP4 inhibitors, widely used in subjects with T2D, are known to modify the biological activities of multiple immunomodulatory substrates. Here, we review the basic and clinical science spanning the intersections of diabetes, coronavirus infections, ACE2, and DPP4 biology, highlighting clinical relevance and evolving areas of uncertainty underlying the pathophysiology and treatment of T2D in the context of coronavirus infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Pneumonia, Viral/complications , Angiotensin-Converting Enzyme 2 , Animals , COVID-19 , Coronavirus Infections/metabolism , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 2/metabolism , Dipeptidyl Peptidase 4/metabolism , Dipeptidyl-Peptidase IV Inhibitors/pharmacology , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Gastrointestinal Tract/metabolism , Humans , Insulin/therapeutic use , Lung/metabolism , Obesity/complications , Obesity/metabolism , Pandemics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/metabolism , Receptors, Coronavirus , Receptors, Virus/metabolism , Risk Factors , SARS-CoV-2 , Serine Endopeptidases/metabolism
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