Frontiers in Endocrinology (Jun 2022)

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

  • Valentino Cherubini,
  • Monica Marino,
  • Andrea E. Scaramuzza,
  • Valentina Tiberi,
  • Adriana Bobbio,
  • Maurizio Delvecchio,
  • Elvira Piccinno,
  • Federica Ortolani,
  • Stefania Innaurato,
  • Barbara Felappi,
  • Francesco Gallo,
  • Carlo Ripoli,
  • Maria Rossella Ricciardi,
  • Filomena Pascarella,
  • Filomena A. Stamati,
  • Felice Citriniti,
  • Claudia Arnaldi,
  • Sara Monti,
  • Vanna Graziani,
  • Fiorella De Berardinis,
  • Cosimo Giannini,
  • Francesco Chiarelli,
  • Maria Zampolli,
  • Rosaria De Marco,
  • Giulia Patrizia Bracciolini,
  • Caterina Grosso,
  • Valeria De Donno,
  • Barbara Piccini,
  • Sonia Toni,
  • Susanna Coccioli,
  • Giuliana Cardinale,
  • Marta Bassi,
  • Nicola Minuto,
  • Giuseppe D’Annunzio,
  • Claudio Maffeis,
  • Marco Marigliano,
  • Angela Zanfardino,
  • Dario Iafusco,
  • Assunta S. Rollato,
  • Alessia Piscopo,
  • Stefano Curto,
  • Fortunato Lombardo,
  • Bruno Bombaci,
  • Silvia Sordelli,
  • Chiara Mameli,
  • Maddalena Macedoni,
  • Andrea Rigamonti,
  • Riccardo Bonfanti,
  • Giulio Frontino,
  • Barbara Predieri,
  • Patrizia Bruzzi,
  • Enza Mozzillo,
  • Francesco Rosanio,
  • Adriana Franzese,
  • Gavina Piredda,
  • Francesca Cardella,
  • Brunella Iovane,
  • Valeria Calcaterra,
  • Maria Giulia Berioli,
  • Anna Lasagni,
  • Valentina Pampanini,
  • Patrizia Ippolita Patera,
  • Riccardo Schiaffini,
  • Irene Rutigliano,
  • Gianfranco Meloni,
  • Luisa De Sanctis,
  • Davide Tinti,
  • Michela Trada,
  • Lucia Paola Guerraggio,
  • Roberto Franceschi,
  • Vittoria Cauvin,
  • Gianluca Tornese,
  • Francesca Franco,
  • Gianluca Musolino,
  • Giulio Maltoni,
  • Valentina Talarico,
  • Antonio Iannilli,
  • Lorenzo Lenzi,
  • Maria Cristina Matteoli,
  • Erica Pozzi,
  • Carlo Moretti,
  • Stefano Zucchini,
  • Ivana Rabbone,
  • Rosaria Gesuita

DOI
https://doi.org/10.3389/fendo.2022.878634
Journal volume & issue
Vol. 13

Abstract

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Aim/HypothesisTo compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019.MethodsForty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019.ResultsOverall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p<0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p<0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively).Conclusions/InterpretationThere was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.

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