Ketoacidosis in new-onset type 1 diabetes: did the severity increase during the COVID-19 pandemic?

OBJECTIVES: Since the beginning of the COVID-19 pandemic, there has been a consistent decrease in the number of admissions to the emergency department, leading to a delay in the diagnosis of several pathologies. The time from onset of symptoms to the diagnosis of Type 1 diabetes is highly variable. This treatment delay can lead to the appearance of ketoacidosis. METHODS: Retrospective study of inaugural Type 1 diabetes cases, from March 2016 to March 2021. The pandemic group was considered between March 2020 to March 2021, and the remaining period was considered as pre-pandemic. Clinical variables were analysed: duration of symptoms, weight loss and value of ketonemia and glycated haemoglobin on admission. The mean differences were considered statistically significant at p<0.05. RESULTS: 103 inaugural episodes of Type 1 diabetes were registered. The pandemic group had a lower mean age when compared to pre-pandemic group, and 51.7% of the episodes had ketoacidosis with a higher relative risk of ketoacidosis and severe ketoacidosis, when compared the pandemic with pre-pandemic group, there was a longer symptom evolution time (34 vs. 20 days), greater weight loss occurred (9.5% vs. 6.3%), the pH and HCO3 - values were lower (7.30 vs. 7.36 and 16.43 vs. 20.71 mmol/L respectively) and ketonemia was higher (5.9 vs. 2.3 mmol/L). CONCLUSIONS: The COVID-19 pandemic caused a delay in the diagnosis of Type 1 diabetes, greater length of disease, greater weight loss, higher ketonemia and lower pH and HCO3 -. There was greater ketoacidosis relative risk in pandemic group when compared to pre-pandemic group.

Adolescent internet addiction - role of parental control and adolescent behaviours.

INTRODUCTION: Excessive Internet use can negatively affect academic performance, family relationships and emotional development among the youth. Such issues have been identified as Internet addiction (IA). We aimed to determine the prevalence of IA among Portuguese adolescents and assess how parental control can relate to IA. METHODS: An observational cross-sectional study was performed at public schools within a Portuguese region, using Young's Internet Addiction Test survey. General sociodemographic and emotional well-being data were obtained. A descriptive and bivariate analysis was done among Internet-addicted and average users, followed by a logistic regression analysis. Adjusted odds ratios (aORs) were computed with two-sided P values < .05 for statistical significance. RESULTS: A total of 1916 eligible responses were obtained. Mean age was 15 ± 1.8 years, with a slight predominance of female (53.3%) participants. In our sample, 16.5% were deemed Internet addicted and less likely to have any parental control over Internet use (aOR 0.74, P <.05). Moreover, 28% of the Internet-addicted users were less likely to have control over time spent online (aOR 0.72, P < .05), and close to half were unlikely to have online content restrictions (aOR 0.56, P < .01). CONCLUSIONS: Our findings reported a significant rate of Internet-addicted youth. IA was negatively related to parental control. Whenever any kind of parental control over Internet use was reported, IA was less likely to occur. Healthcare professionals should be aware of the risks of IA in adolescents to improve its prevention and intervention.