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Meta-Analysis
. 2022 Mar 9:13:856958.
doi: 10.3389/fendo.2022.856958. eCollection 2022.

Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies

Osamah M Alfayez  1 , Kholood S Aldmasi  2 , Nada H Alruwais  2 , Nouf M Bin Awad  3 , Majed S Al Yami  4 , Omar A Almohammed  5   6 , Abdulaali R Almutairi  7
Affiliations
Meta-Analysis

Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies

Osamah M Alfayez et al. Front Endocrinol (Lausanne). .

Abstract

Background: Previous reports suggest that the Coronavirus Disease-2019 (COVID-19) pandemic might have affected incidences of diabetic ketoacidosis (DKA) and new diagnoses of type 1 diabetes. This systematic review and meta-analysis aimed to estimate the risk of DKA, including severe DKA, during the COVID-19 pandemic versus the prior-to-COVID-19 period among pediatric patients with type 1 diabetes.

Methods: PubMed and EMBASE were searched for observational studies investigating the risk of DKA among pediatric patients with type 1 diabetes during the COVID-19 pandemic and the prior-to-COVID-19 period. A random meta-analysis model was performed to estimate the relative risk of DKA during the COVID-19 pandemic compared to before the pandemic. Subgroup analyses were conducted based on the type 1 diabetes status, established or newly diagnosed. In addition, sensitivity analysis was conducted for studies that reported results from adjusted analysis for potential confounders using fixed effect model.

Results: A total of 20 observational studies reported the risk of DKA, of which 18 reported the risk of severe DKA. The risks of DKA and severe DKA were 35% (RR 1.35, 95%CI 1.2-1.53, I2 = 71%) and 76% (RR 1.76, 95%CI 1.33-2.33, I2 = 44%) higher in the during-COVID-19 group compared to the prior-to-COVID-19 group, respectively. Among patients with newly diagnosed type 1 diabetes, the risk of DKA was 44% higher for the during-COVID-19 group compared to the prior-to-COVID-19 group (RR 1.44, 95%CI 1.26-1.65; I2 = 64%). Only two studies reported the risk of DKA among patients with established type 1 diabetes and the cumulative risk was not statistically significant. In the sensitivity analysis, four studies reported an adjusted odds ratio (aOR) of the risk of DKA during COVID-19 compared to the prior-to-COVID-19 period. The fixed estimate from the meta-analysis found an increase in the risk of DKA in the during-COVID-19 group compared to the prior-to-COVID-19 group (aOR 2.04, 95%CI 1.66-2.50).

Conclusions: This study showed that DKA risk, especially the risk of severe DKA, has increased significantly during the pandemic. Healthcare systems must be aware and prepared for such an increase in DKA cases and take all necessary measures to prevent future spikes during the pandemic.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272775, identifier PROSPERO [CRD42021272775].

Keywords: COVID-19; diabetic ketoacidosis; incidence; meta-analysis; pediatrics; systematic review; type 1 diabetes.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA Flowchart of included and excluded studies. Copyright statement: this PRISMA diagram contains public sector information licensed under the Open Government Licence v3.0. Adapted From: Moher et al. (23).
Figure 2
Figure 2
Risk of DKA among patients with type 1 diabetes.
Figure 3
Figure 3
Risk of severe DKA among patients with type 1 diabetes.
Figure 4
Figure 4
Risk of DKA among patients with newly diagnosed type 1 diabetes.
Figure 5
Figure 5
Risk of DKA among patients with established type 1 diabetes.
See this image and copyright information in PMC

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References

    1. Duca LM, Wang B, Rewers M, Rewers A. Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor Long-Term Glycemic Control. Diabetes Care (2017) 40(9):1249–55. doi: 10.2337/dc17-0558 - DOI - PubMed
    1. Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodriguez B, et al. . Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth: The Search for Diabetes in Youth Study. Pediatrics (2008) 121(5):e1258–66. doi: 10.1542/peds.2007-1105 - DOI - PubMed
    1. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic Ketoacidosis. Nat Rev Dis Prim (2020) 6(1):1–20. doi: 10.1038/s41572-020-0165-1 - DOI - PubMed
    1. Umpierrez GE, Kitabchi AE. Diabetic Ketoacidosis: Risk Factors and Management Strategies. Treat Endocrinol (2003) 2(2):95–108. doi: 10.2165/00024677-200302020-00003 - DOI - PubMed
    1. Saydah SH, Shrestha SS, Zhang P, Zhou X, Imperatore G. Medical Costs Among Youth Younger Than 20 Years of Age With and Without Diabetic Ketoacidosis at the Time of Diabetes Diagnosis. Diabetes Care (2019) 42(12):2256–61. doi: 10.2337/DC19-1041 - DOI - PMC - PubMed