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. 2022 Jun 17:13:878634.
doi: 10.3389/fendo.2022.878634. eCollection 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  1 , Monica Marino  1 , Andrea E Scaramuzza  2 , Valentina Tiberi  1 , Adriana Bobbio  3 , Maurizio Delvecchio  4 , Elvira Piccinno  4 , Federica Ortolani  4 , Stefania Innaurato  5 , Barbara Felappi  6 , Francesco Gallo  7 , Carlo Ripoli  8 , Maria Rossella Ricciardi  8 , Filomena Pascarella  9 , Filomena A Stamati  10 , Felice Citriniti  11 , Claudia Arnaldi  12 , Sara Monti  13 , Vanna Graziani  13 , Fiorella De Berardinis  14 , Cosimo Giannini  15 , Francesco Chiarelli  15 , Maria Zampolli  16 , Rosaria De Marco  17 , Giulia Patrizia Bracciolini  18 , Caterina Grosso  18 , Valeria De Donno  19 , Barbara Piccini  20 , Sonia Toni  20 , Susanna Coccioli  21 , Giuliana Cardinale  22 , Marta Bassi  23 , Nicola Minuto  23 , Giuseppe D'Annunzio  23 , Claudio Maffeis  24 , Marco Marigliano  24 , Angela Zanfardino  25 , Dario Iafusco  25 , Assunta S Rollato  25 , Alessia Piscopo  25 , Stefano Curto  25 , Fortunato Lombardo  26 , Bruno Bombaci  26 , Silvia Sordelli  27 , Chiara Mameli  28 , Maddalena Macedoni  28 , Andrea Rigamonti  29 , Riccardo Bonfanti  29 , Giulio Frontino  29 , Barbara Predieri  30 , Patrizia Bruzzi  30 , Enza Mozzillo  31 , Francesco Rosanio  31 , Adriana Franzese  31 , Gavina Piredda  32 , Francesca Cardella  33 , Brunella Iovane  34 , Valeria Calcaterra  35 , Maria Giulia Berioli  36 , Anna Lasagni  37 , Valentina Pampanini  38 , Patrizia Ippolita Patera  38 , Riccardo Schiaffini  38 , Irene Rutigliano  39 , Gianfranco Meloni  40 , Luisa De Sanctis  41 , Davide Tinti  41 , Michela Trada  41 , Lucia Paola Guerraggio  42 , Roberto Franceschi  43 , Vittoria Cauvin  43 , Gianluca Tornese  44 , Francesca Franco  45 , Gianluca Musolino  42 , Giulio Maltoni  46 , Valentina Talarico  11 , Antonio Iannilli  1 , Lorenzo Lenzi  20 , Maria Cristina Matteoli  38 , Erica Pozzi  47 , Carlo Moretti  48 , Stefano Zucchini  46 , Ivana Rabbone  47 , Rosaria Gesuita  49
Affiliations

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 et al. Front Endocrinol (Lausanne). .

Erratum in

  • Corrigendum: 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.
    Cherubini V, Marino M, Scaramuzza AE, Tiberi V, Bobbio A, Delvecchio M, Piccinno E, Ortolani F, Innaurato S, Felappi B, Gallo F, Ripoli C, Ricciardi MR, Pascarella F, Stamati FA, Citriniti F, Arnaldi C, Monti S, Graziani V, De Berardinis F, Giannini C, Chiarelli F, Zampolli M, De Marco R, Bracciolini GP, Grosso C, De Donno V, Piccini B, Toni S, Coccioli S, Cardinale G, Bassi M, Minuto N, D'Annunzio G, Maffeis C, Marigliano M, Zanfardino A, Iafusco D, Rollato AS, Piscopo A, Curto S, Lombardo F, Bombaci B, Sordelli S, Mameli C, Macedoni M, Rigamonti A, Bonfanti R, Frontino G, Predieri B, Bruzzi P, Mozzillo E, Rosanio F, Franzese A, Piredda G, Cardella F, Iovane B, Calcaterra V, Berioli MG, Lasagni A, Pampanini V, Patera PI, Schiaffini R, Rutigliano I, Meloni G, De Sanctis L, Tinti D, Trada M, Guerraggio LP, Franceschi R, Cauvin V, Tornese G, Franco F, Musolino G, Maltoni G, Talarico V, Iannilli A, Lenzi L, Matteoli MC, Pozzi E, Moretti C, Zucchini S, Rabbone I, Gesuita R. Cherubini V, et al. Front Endocrinol (Lausanne). 2022 Aug 4;13:977211. doi: 10.3389/fendo.2022.977211. eCollection 2022. Front Endocrinol (Lausanne). 2022. PMID: 35992112 Free PMC article.

Abstract

Aim/hypothesis: To 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.

Methods: Forty-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.

Results: Overall, 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/interpretation: There 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.

Keywords: COVID - 19; DKA; diabetes onset; socioeconomic status; type 1 diabetes.

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Conflict of interest statement

No author reported any conflict of interest as regards this study. The following conflicts of interest pointed out are referred to a period from January 2020 to the submission of this manuscript. VCh’s institution has received research grants from AstraZeneca, Novonordisk, Eli Lilly, Movi, Dompè, and Menarini, and VCh received honoraria from Eli Lilly, Tandem, and Insulet for participating on speakers’ bureaus and scientific advisory boards. CR, DT, IRa, BPr, BPi, SZ, ST, and AR has received support Eli Lilly. In addition, SZ’s institution has received support from Pfeizer, ST, BPi, and DT have received support from Abbott and Theras. MM and AR have received support from Menarini. BPr and PB received honoraria for participating on speakers’ bureaus and scientific advisory boards for Sandoz. Lastly, RS has received research grants by Sanofi and received honoraria for participating on speakers’ bureaus and scientific advisory boards for Movi. The remaining 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
Number of daily deaths from the COVID-19 pandemic in Italy in 2020, and monthly frequency of DKA and severe DKA based on government restriction periods in 2020 compared with the three-year period 2017-2019.
See this image and copyright information in PMC

References

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