DKA rates rise for youths with type 1 diabetes in countries with higher COVID-19 mortality
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Diabetic ketoacidosis events increased among youths with type 1 diabetes in the U.S. and other countries hit hard by the first wave of the COVID-19 pandemic, according to a study published in Diabetes Technology and Therapeutics.
Data from the Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry showed HbA1c levels for youths with type 1 diabetes were similar during the early months of the COVID-19 pandemic compared with the year prior. However, there was a large increase in DKA rates, especially in countries most affected by COVID-19.
“The DKA rates increased nearly twofold in Belgium, Chile, England, France, Ireland, Italy, Netherlands, Spain, Sweden and the U.S., albeit the countries with the highest COVID-19 mortality during the first wave,” Thomas Danne, MD, professor of pediatrics at Children’s Hospital Auf der Bult in Hannover, Germany, told Healio. “This may reflect the impact on general health care delivery in these countries.”
Higher DKA rates during first wave
Danne and colleagues analyzed data from youths with type 1 diabetes aged 21 years or younger from 82 diabetes centers in the SWEET registry. All participants had data available from May to June 2019 and May to June 2020. HbA1c was used to assess glycemic management, and any continuous glucose monitor use was analyzed. Researchers also collected data on severe hypoglycemia and DKA events. Researchers divided diabetes centers into quartiles based on COVID-19-associated mortality in each country during the first wave. Data on outcome variables among people with type 1 diabetes for August to September 2019 and 2020, the period immediately preceding the second wave, were also analyzed as a control period.
Data were available for 16,735 children in 2019 and 12,175 children in 2020. Across all quartiles, HbA1c and severe hypoglycemia rates were comparable in May and June 2020 to the same months in 2019. DKA rates increased significantly in May and June 2020 in the quartile of countries with the highest COVID-19 mortality rate. The two quartiles with the highest COVID-19 mortality also had lower CGM use and higher daily insulin doses in May and June 2020.
CGM use increases in August and September
In August and September 2020, both DKA rates and insulin doses returned to levels similar to 2019. CGM use increased significantly in all quartiles in August and September 2020 compared with 2019.
“We were surprised about the immediate significant global rise of CGM use as a response to the crisis,” Danne said. “In contrast, other diabetes technology like insulin pumps remained unchanged. Possibly, the option of telemedicine and establishing a virtual diabetes clinic during the time of the pandemic with CGM data being uploaded through the cloud for joint assessment of families and diabetes teams has contributed to maintaining glycemic control during the pandemic.”
Danne said data from the SWEET registry will continue to be analyzed for later periods of the COVID-19 pandemic so trends and outcomes can continue to be tracked for youths with type 1 diabetes.
“Future analysis in time periods of subsequent waves during the pandemic will elucidate if measures like the increasing use of CGM in the time after the first lockdown prevented a reoccurrence of COVID-19-associated increased DKA rates,” Danne said. “Also, we will see if differences in national vaccination strategies and other public health measures can be associated with outcomes in children with diabetes.”
For more information:
Thomas Danne, MD, can be reached at danne@hka.de.
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