Diabetes pandemic
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The Diabetes Pandemic During COVID-19
Increased Incidence of Type 1 Diabetes in Children
Rising Rates of Type 1 Diabetes
The COVID-19 pandemic has been associated with a significant increase in the incidence of type 1 diabetes (T1D) among children and adolescents. A systematic review and meta-analysis revealed a 16% higher incidence rate of childhood T1D during the first 12 months of the pandemic and a 28% increase during the subsequent 12 months compared to the year before the pandemic. This rise is notably higher than the pre-pandemic annual increase of 2% to 3%. Similarly, data from the SWEET registry showed that the number of new-onset T1D cases in children increased significantly from 2018 to 2021 across various age groups.
Seasonal Variations and Delays
The pandemic also altered the typical seasonality of T1D onset. In Europe and North America, the usual winter peak was delayed, with a higher incidence observed during the summer and autumn months of 2020. This shift in seasonality returned to pre-pandemic patterns in Europe by 2021, but not in North America.
Global Trends and Regional Differences
A meta-analysis comparing pre-pandemic and pandemic periods found a 20% increase in the incidence rate of T1D in children globally. In Germany, the incidence of T1D in children during the pandemic was significantly higher than expected, with notable peaks in mid-2020 and early 2021. In the United States, a retrospective review at a tertiary care center also indicated an increased incidence of new-onset T1D during the pandemic.
Diabetic Ketoacidosis (DKA) and Glycemic Control
Increased DKA Incidence
The pandemic has exacerbated the prevalence of diabetic ketoacidosis (DKA) at the diagnosis of T1D. Studies have shown a marked increase in the number of children presenting with DKA during the pandemic . The global incidence of DKA and severe DKA increased by 25% and 19.5%, respectively, during the first year of the pandemic.
Worsening Glycemic Control
Higher average HbA1c levels were observed in children newly diagnosed with T1D during the pandemic compared to pre-pandemic levels. For instance, in the SWEET registry, average HbA1c levels increased from 7.7% in 2018-2019 to 8.6% in 2021. This trend underscores the challenges in maintaining optimal glycemic control during the pandemic.
Diabetes Management During the Pandemic
Barriers to Care
The COVID-19 pandemic has posed significant barriers to diabetes management. Lockdowns and healthcare disruptions have limited access to routine care, leading to delayed diagnoses and suboptimal management of diabetes. This has been particularly challenging for vulnerable groups such as children, adolescents, and the elderly.
Self-Management and Education
To mitigate these challenges, there has been a shift towards patient-centered care and diabetes self-management education (DSME). This approach emphasizes the importance of glycemic control, dietary management, physical activity, and medication adherence. Effective DSME can help patients manage their condition better amid the ongoing pandemic.
Conclusion
The COVID-19 pandemic has significantly impacted the incidence and management of type 1 diabetes in children. The increased incidence of T1D, higher rates of DKA, and worsening glycemic control highlight the need for targeted interventions and improved diabetes care strategies. Enhanced self-management education and patient-centered care are crucial to help diabetic patients navigate the challenges posed by the pandemic.
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