A Worldwide Perspective on COVID-19 and Diabetes Management in 22,820 Children from the SWEET Project: Diabetic Ketoacidosis Rates Increase and Glycemic Control Is Maintained
Publication: Diabetes Technology & Therapeutics
Volume 23, Issue Number 9
Abstract
Aims: To investigate the short-term effects of the first wave of COVID-19 on clinical parameters in children with type 1 diabetes (T1D) from 82 worldwide centers participating in the Better Control in Pediatric and Adolescent DiabeteS: Working to CrEate CEnTers of Reference (SWEET) registry.
Materials and Methods: Aggregated data per person with T1D ≤21 years of age were compared between May/June 2020 (first wave), August/September 2020 (after wave), and the same periods in 2019. Hierarchic linear and logistic regression models were applied. Models were adjusted for gender, age-, and diabetes duration-groups. To distinguish the added burden of the COVID-19 pandemic, the centers were divided into quartiles of first wave COVID-19-associated mortality in their country.
Results: In May/June 2019 and 2020, respectively, there were 16,735 versus 12,157 persons, 52% versus 52% male, median age 13.4 (Q1; Q3: 10.1; 16.2) versus13.5 (10.2; 16.2) years, T1D duration 4.5 (2.1; 7.8) versus 4.5 (2.0; 7.8) years, and hemoglobin A1c (HbA1c) 60.7 (53.0; 73.8) versus 59.6 (50.8; 70.5) mmol/mol [7.8 (7.0; 8.9) versus 7.6 (6.8; 8.6) %]. Across all country quartiles of COVID-19 mortality, HbA1c and rate of severe hypoglycemia remained comparable to the year before the first wave, while diabetic ketoacidosis rates increased significantly in the centers from countries with the highest mortality rate, but returned to baseline after the wave. Continuous glucose monitoring use decreased slightly during the first wave (53% vs. 51%) and increased significantly thereafter (55% vs. 63%, P < 0.001).
Conclusions: Although glycemic control was maintained, a significant rise in DKA at follow-up was seen during first wave in the quartile of countries with the highest COVID mortality.
Trial Registration: NCT04427189.
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References
1. Green A, Møller Hede S, Patterson CC, et al.: Type 1 diabetes in 2017- Global estimates of incident and prevalent cases in children and adults. Lancet 2021;397 (accepted for publication).
2. Danne T, Limbert C: COVID-19 pandemic, type 1 diabetes and technology: why paediatric patients are leading the way. Lancet Diabetes Endocrinol 2020;8:465–467.
3. March CA, Flint A, DeArment D, et al.: Paediatric diabetes care during the COVID-19 pandemic: lessons learned in scaling up telemedicine services. Endocrinol Diabetes Metab 2020;:e00202.
4. International Society of Pediatric and Adolescent Diabetes (ISPAD): Summary of recommendations regarding COVID-19 in children with diabetes: keep Calm and Mind your Diabetes Care and Public Health Advice. Pediatr Diabetes 2020;21:413–414.
5. Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol 2020;8:823–833.
6. Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol 2020;10:813–822.
7. Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD: How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet 2020;395:931–934.
8. Cardona-Hernandez R, Cherubini V, Iafusco D, et al.: Children and youth with diabetes are not at increased risk for hospitalization due to COVID-19. Pediatr Diabetes 2021;22:202–206.
9. DiMeglio LA, Albanese-O'Neill A, Muñoz CE, Maahs DM: COVID-19 and children with diabetes-updates, unknowns, and next steps: first, do no extrapolation. Diabetes Care 2020;43:2631–2634.
10. Gerhardsson P, Schwandt A, Witsch M, et al: The SWEET project: benchmarking over 10 years is associated with improved HbA1c and increased use of diabetes technology in youth with type 1 diabetes from 19 countries worldwide. Diab Tech Ther 2021 [Online ahead of print].
11. Wolfsdorf JI, Glaser N, Agus M, et al.: ISPAD clinical practice consensus guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19(Suppl. 27):155–177.
12. Abraham MB, Jones TW, Naranjo D, et al.: ISPAD clinical practice consensus guidelines 2018: assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2018;19(Suppl. 27):178–192.
13. Kamrath C, Mönkemöller K, Biester T, et al.: Ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the COVID-19 pandemic in Germany. JAMA 2020;324:801–804.
14. Rabbone I, Schiaffini R, Cherubini V, Maffeis C, et al.: Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children? Diabetes Care 2020;10:dc201321.
15. Piccini B, Schwandt A, Jefferies C, et al.: Association of diabetic ketoacidosis and HbA1c at onset with year-three HbA1c in children and adolescents with type 1 diabetes: data from the international SWEET registry. Pediatr Diabetes 21:339–348.
16. Maahs DM, Hermann JM, Holman N, et al. Rates of diabetic ketoacidosis: international comparison with 49,859 pediatric patients with type 1 diabetes from England, Wales, the U.S., Austria, and Germany. Diabetes Care 2015;38:1876–1882.
17. Christoforidis A, Kavoura E, Nemtsa A, et al.: Coronavirus lockdown effect on type 1 diabetes management on children wearing insulin pump equipped with continuous glucose monitoring system. Diabetes Res Clin Pract 2020;166:108307.
18. Capaldo B, Annuzzi G, Creanza A, et al. Blood glucose control during lockdown for COVID-19: CGM metrics in Italian adults with type 1 diabetes. Diabetes Care 2020;43:e88–e89.
19. Fernández E, Cortazar, Bellidoa V: Impact of COVID-19 lockdown on glycemic control in patients with type 1 diabetes. Diabetes Res Clin Pract 2020;166:108348.
20. Valitutti F, Zenzeri L, Mauro A, et al. Effect of population lockdown on pediatric emergency room demands in the era of COVID-19. Front Pediatr 2020;8:521.
21. Dopfer C, Wetzke M, Zychlinsky Scharff A, et al.: COVID-19 related reduction in pediatric emergency healthcare utilization—a concerning trend. BMC Pediatr 2020;20:427.
22. Sumnik Z, Szypowska A, Iotova V, et al.: Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: the SWEET perspective. Pediatr Diabetes 2019;20:434–443.
23. Lazzerini M, Barbi E, Apicella A, et al.: Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health 2020;4:e10–e11.
24. Cardona-Hernandez R, Schwandt A, Alkandari H, et al.: Glycemic outcome associated with insulin pump and glucose sensor use in children and adolescents with type 1 diabetes. Data from the international pediatric registry SWEET. Diabetes Care 2021;44:1176–1184.
25. Powers AC, Aronoff DM, Eckel RH: COVID-19 vaccine prioritisation for type 1 and type 2 diabetes. Lancet Diabetes Endocrinol 2021;9:140–141.
26. Williamson EJ, Walker AJ, Bhaskaran K, et al.: Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430–436.
27. O'Malley G, Ebekozien O, Desimone M, et al.: COVID-19 Hospitalization in Adults with Type 1 Diabetes: results from the T1D Exchange Multicenter Surveillance Study. J Clin Endocrinol Metab 2021;106:e936–e942.
28. Wargny M, Gourdy P, Ludwig L, et al.: Type 1 diabetes in people hospitalized for COVID-19: new insights from the CORONADO study. Diabetes Care 43:e174–e177.
29. Gregory JM, Slaughter JC, Duffus SH, et al. COVID-19 severity is tripled in the diabetes community: a prospective analysis of the pandemic's impact in type 1 and type 2 diabetes. Diabetes Care 2021;44:526–532.
30. McGurnaghan SJ, Weir A, Bishop J, et al.: Public Health Scotland COVID-19 Health Protection Study Group; Scottish Diabetes Research Network Epidemiology Group: Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland. Lancet Diabetes Endocrinol 2020;9:82–93.
31. Ständige Impfkommission am Robert Koch-Institut (2021) Beschluss der STIKO zur 2. Aktualisierung der COVID-19-Impfempfehlung und die dazugehörige wissenschaftliche Begründung. https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2021/Ausgaben/05_21.pdf?__blob=publicationFile (accessed February 5, 2021).
32. Dooling K, Marin M, Wallace M et al.: The Advisory Committee on Immunization Practices' updated interim recommendation for allocation of COVID-19 vaccine—United States, Dec 2020. MMWR Morb Mortal Wkly Rep 2021;69:1657–1660.
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Information
Published In
Diabetes Technology & Therapeutics
Volume 23 • Issue Number 9 • September 2021
Pages: 632 - 641
PubMed: 34086503
Copyright
Copyright 2021, Mary Ann Liebert, Inc., publishers.
History
Published in print: September 2021
Published online: 1 September 2021
Published ahead of print: 18 August 2021
Published ahead of production: 4 June 2021
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Authors
Authors' Contributions
All authors contributed to the study concept and design. T.D. and S.L. supervised the study. S.L. analyzed the data. All authors participated in data interpretation. T.D., M.d.B., and E.T.R. drafted the first version of the article. The final article was reviewed and approved by all. T.D. is the guarantor of the study and takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the article.
Author Disclosure Statement
T.D. has received speaker's honoraria and research support from and has consulted for Abbott, AstraZeneca, Boehringer, DexCom, Lilly, Medtronic, Novo Nordisk, Roche, Sanofi, and Ypsomed and is a shareholder of DreaMed Ltd. E.T.R. is the Site Principal Investigator for a Phase 3 clinical trial sponsored by AstraZeneca. P.B. has received speaker's honoraria from Sanofi, Novo Nordisk, Lilly, Abbott, and Vitalaire. K.D. has received speaker's honoraria from Abbott, Novo Nordisk, and Sanofi. S.L., M.d.B., G.T.A., Y.E., M.K., B.S., M.S.P., and A.C. declare that there is no duality of interest associated with their contribution to this article.
Funding Information
SWEET is a registered nonprofit charity in Hannover, Germany. It is financed through membership fees of the participating centers (based on income of country of residence according to the World Bank) and corporate members. We acknowledge with gratitude the support from the following SWEET e.V. corporate members—in alphabetical order: Abbott, Boehringer Ingelheim, DexCom, Inc., Insulet, Eli Lilly & Co., Medtronic Europe, Sanofi.
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