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Meta-Analysis
. 2023 Apr;93(5):1149-1160.
doi: 10.1038/s41390-022-02241-2. Epub 2022 Aug 11.

Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes

Anas Elgenidy #  1 , Ahmed K Awad #  2 , Khaled Saad  3 , Mostafa Atef  1 , Hatem Helmy El-Leithy  1 , Ahmed A Obiedallah  4 , Emad M Hammad  5 , Faisal-Alkhateeb Ahmad  5 , Ahmad M Ali  5 , Hamad Ghaleb Dailah  6 , Amira Elhoufey  7   8 , Samaher Fathy Taha  5
Affiliations
Meta-Analysis

Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes

Anas Elgenidy et al. Pediatr Res. 2023 Apr.

Abstract

Background: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes mellitus (T1DM) that has increased during the COVID-19 pandemic. This study will not only shed light on such life-threatening complications but also be a step to increase the awareness of healthcare providers about such complications in the upcoming pandemic waves and increased dependence on telemedicine. Thus, we aimed to further investigate the increase of DKA in pediatrics.

Methods: PubMed, Web of Science, and Scopus were broadly searched for studies assessing the incidence of DKA in pediatrics during the COVID-19 pandemic.

Results: Our study included 24 papers with a total of 124,597 children with diabetes. A statistically significant increase occurred in the risk of DKA among newly diagnosed T1DM patients during the pandemic (RR 1.41; 95% CI 1.19, 1.67; p < 0.01; I2 = 86%), especially in the severe form of DKA (RR 1.66: 95% CI 1.3, 2.11) when compared to before.

Conclusion: DKA in newly diagnosed children with T1DM has increased during the pandemic and presented with a severe form. This may reflect that COVID-19 may have contributed not only to the development but also the severity of DKA.

Impact: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) that has increased during the COVID-19 pandemic. Our study included 25 papers with a total of 124,597 children with diabetes. A statistically significant increase occurred in the risk of DKA among newly diagnosed T1DM patients during the pandemic. Our findings reflect that COVID-19 may have an altered presentation in T1DM and can be related to DKA severity.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. PRISMA flowchart.
The PRISMA flow diagram for the systematic review detailing the database searches, the number of Records screened, and the full texts retrieved.
Fig. 2
Fig. 2. Forest for DKA.
Forest plot summarizing the risk ratio of DKA in pre-pandemic and post-pandemic stratified by the onset of diabetes (new-onset, pre-existing or mixed of both). SD standard deviation, CI confidence interval.
Fig. 3
Fig. 3. Forest for degree.
Forest plot summarizing the risk ratio of DKA in pre-pandemic and post-pandemic stratified by the degree of DKA (severe, moderate, or mild). SD standard deviation, CI confidence interval.
Fig. 4
Fig. 4. Funnel plots.
Funnel plots showing publication bias in studies included in the analysis calculating the risk ratio of DKA in pre-pandemic and post-pandemic stratified by the onset of diabetes, and for the studies included in the analysis calculating the risk ratio of DKA in pre-pandemic and post-pandemic stratified by the degree of DKA.
Fig. 5
Fig. 5. Leave for DKA.
Leave-one-out meta-analysis of studies calculating the risk ratio of DKA in pre-pandemic and post-pandemic stratified by the onset of diabetes, CI confidence interval.
Fig. 6
Fig. 6. Leave for the degree.
Leave-one-out meta-analysis of studies calculating the risk ratio of DKA in pre-pandemic and post-pandemic stratified by the degree of DKA, CI confidence interval.
See this image and copyright information in PMC

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