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

被引：21

作者：

Cherubini, Valentino ^{[1
]}

Marino, Monica ^{[1
]}

Scaramuzza, Andrea E. ^{[2
]}

Tiberi, Valentina ^{[1
]}

Bobbio, Adriana ^{[3
]}

Delvecchio, Maurizio ^{[4
]}

Piccinno, Elvira ^{[4
]}

Ortolani, Federica ^{[4
]}

Innaurato, Stefania ^{[5
]}

Felappi, Barbara ^{[6
]}

Gallo, Francesco ^{[7
]}

Ripoli, Carlo ^{[8
]}

Ricciardi, Maria Rossella ^{[8
]}

Pascarella, Filomena ^{[9
]}

Stamati, Filomena A. ^{[10
]}

Citriniti, Felice ^{[11
]}

Arnaldi, Claudia ^{[12
]}

Monti, Sara ^{[13
]}

Graziani, Vanna ^{[13
]}

De Berardinis, Fiorella ^{[14
]}

Giannini, Cosimo ^{[15
]}

Chiarelli, Francesco ^{[15
]}

Zampolli, Maria ^{[16
]}

De Marco, Rosaria ^{[17
]}

Bracciolini, Giulia Patrizia ^{[18
]}

Grosso, Caterina ^{[18
]}

De Donno, Valeria ^{[19
]}

Piccini, Barbara ^{[20
]}

Toni, Sonia ^{[20
]}

Coccioli, Susanna ^{[21
]}

Cardinale, Giuliana ^{[22
]}

Bassi, Marta ^{[23
]}

Minuto, Nicola ^{[23
]}

D'Annunzio, Giuseppe ^{[23
]}

Maffeis, Claudio ^{[24
,25
]}

Marigliano, Marco ^{[24
,25
]}

Zanfardino, Angela ^{[26
]}

Iafusco, Dario ^{[26
]}

Rollato, Assunta S. ^{[26
]}

Piscopo, Alessia ^{[26
]}

Curto, Stefano ^{[26
]}

Lombardo, Fortunato ^{[27
]}

Bombaci, Bruno ^{[27
]}

Sordelli, Silvia ^{[28
]}

Mameli, Chiara ^{[29
]}

Macedoni, Maddalena ^{[29
]}

Rigamonti, Andrea ^{[30
]}

Bonfanti, Riccardo ^{[30
]}

Frontino, Giulio ^{[30
]}

Predieri, Barbara ^{[31
]}

机构：

[1] G Salesi Hosp, Dept Womens & Childrens Hlth, Azienda Osped Univ, Osped Riuniti Ancona, Ancona, Italy

[2] Osped Maggiore, Pediat Unit, Pediat Diabet, Endocrinol & Nutr,ASST Cremona, Cremona, Italy

[3] Beauregard Hosp, Pediat Unit, Aosta, Italy

[4] Giovanni XXIII Childrens Hosp, Metab Dis & Genet Disorders Unit, Bari, Italy

[5] San Bortolo Hosp, Maternal & Child Hlth Dept, Pediat Unit, Vicenza, Italy

[6] Childrens Hosp, Pediat Clin, ASST Spedali Civili Brescia, Brescia, Italy

[7] Perrino Hosp, Unit Pediat, Brindisi, Italy

[8] AO Brotzu, Pediat & Microcytemia Dept, Pediat Diabetol Unit, Cagliari, Italy

[9] St Anna & San Sebastiano Hosp, Pediat Endocrinol Unit, Caserta, Italy

[10] Spoke Hosp, Unit Pediat, UOSD Pediat Diabetol & Metab Unit, Castrovillari, Cozensa, Italy

[11] Pugliese Ciaccio Hosp, Dept Pediat, Catanzaro, Italy

[12] UOS Pediat Diabetol ASL Viterbo, Viterbo, Lazio, Italy

[13] AUSL Romagna Ravenna, M Bufalini Hosp Cesena FC, Unit Paediat, SM Croci Hosp Ravenna RA, Ravenna, Emilia Romagna, Italy

[14] Spoke Hosp Cetraro, Pediat Unit, Cetraro, Calabria, Italy

[15] Univ G dAnnunzio, Dept Pediat, Chieti, Italy

[16] St Anna Hosp, Dept Pediat, ASST Lariana, Como, Italy

[17] UASP Cosenza, Cosenza, Italy

[18] ASO SS Antonio Biagio & Cesare Arrigo, Children Hosp, Pediat & Pediat Emergency unit, Alessandria, Italy

[19] ASO S Croce & Carle, Unit Pediat, Cuneo, Italy

[20] Meyer Univ, Diabetol & Endocrinol Unit, Childrens Hosp, Florence, Italy

[21] D Camberlingo Hosp, Unit Pediat, Francavilla Fontana, Brindisi, Italy

[22] Sacro Cuore Gesu Hosp Gallipoli LE, Unit Pediat, Gallipoli, Italy

[23] Univ Genoa, Dept Neurosci Rehabil Ophtalmol Genet Maternal & C, Pediat Clin, IRCCS Giannina Gaslini, Genoa, Italy

[24] Univ Verona, Dept Surg Dent Pediat & Gynecol, Sect Pediat Diabet & Metab, Verona, Italy

[25] Azienda Osped Univ Integrata Verona, Verona, Italy

[26] Univ Campania L Vanvitelli, Reg Ctr Pediat Diabet, Dept Woman Child & Gen & Specialist Surg, Naples, Italy

[27] Univ Messina, Dept Human Pathol Adulthood & Childhood G Barresi, Messina, Italy

[28] ASST Carlo Poma, Dept Pediat, Mantua, Italy

[29] Univ Milan, Dept Pediat, V Buzzi Childrens Hosp, Milan, Lombardy, Italy

[30] IRCCS San Raffaele, Diabet Res Inst, Dept Pediat, Milan, Italy

[31] Univ Modena & Reggio Emilia, Dept Med & Surg Sci Mother Children & Adults, Pediat Unit, Modena, Italy

[32] Univ Napoli Federico II, Dept Translat Med Sci, Sect Pediat, Naples, Italy

[33] ASSL Olbia, Giovanni Paolo II Hosp, Unit Paediat, Olbia, Italy

[34] Children Hosp G Di Cristina, Reg Ctr Pediat Diabet, Dept Pediat, Palermo, Italy

[35] Parma Univ Hosp, Dept Mother & Child Pediat, Parma, Italy

[36] Univ Pavia, Dept Internal Med & Therapeut, Milan, Italy

[37] Vittore Buzzi Chidrens Hosp, Milan, Italy

[38] Azienda Osped Perugia, Pediat Diabetol Dept, Perugia, Umbria, Italy

[39] Azienda AUSL IRCCS Reggio Emilia, Dept Obstet Gynaecol & Paediat, Pediat Unit, Reggio Emilia, Italy

[40] Bambino Gesu Pediat Hosp Roma, Pediat Diabetol Dept, Rome, Lazio, Italy

[41] Casa Sollievo Sofferenza Res Inst, San Giovanni Rotondo, Puglia, Italy

[42] Univ Sassari, Dept Med Surg & Expt Sci, Sassari, Italy

[43] AOU Citta Salute & Sci Torino, Ctr Pediat Diabetol, Turin, Italy

[44] ASST Sette Laghi, Filippo Del Ponte Children Hosp, Ctr Paediat Diabetol, Paediat Unit, Varese, Italy

[45] S Chiara Hosp Trento, Dept Pediat, Trento, Trentino Alto A, Italy

[46] IRCCS Burlo Garofolo, Inst Maternal & Child Hlth, Trieste, Italy

[47] ASUFC Hosp Udine, Pediat Dept, Udine, Friuli Venezia, Italy

[48] ASST Sette Laghi, Filippo Del Ponte Children Hosp, Ctr Paediat Diabetol, Paediat Unit, Varese, Italy

[49] Univ Bologna, Pediat Endocrine Unit, IRCCS Azienda Osped, Bologna, Italy

[50] Univ Piemonte Orientale, Dept Hlth Sci, Div Pediat, Novara, Italy

来源：

FRONTIERS IN ENDOCRINOLOGY | 2022年 / 13卷

关键词：

DKA; COVID; 19; type; 1; diabetes; socioeconomic status; diabetes onset;

D O I：

10.3389/fendo.2022.878634

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aim/HypothesisTo 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. MethodsForty-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. ResultsOverall, 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/InterpretationThere 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.

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