Diabetes-related mortality, pediatric DKA rates increased during COVID-19 pandemic
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Key takeaways:
- Thirteen studies reported a rise in diabetes-related mortality during the COVID-19 pandemic.
- Increases in hospital admissions were more common among children than adults.
Most studies found increases in diabetes-related mortality for adults and diabetes ketoacidosis incidence among youths during the COVID-19 pandemic compared with before the pandemic, according to a systematic review.
“The COVID-19 pandemic and associated disruptions in health care provision were associated with increased diabetes-related morbidity and mortality, outside of COVID infection itself,” Jamie Hartmann-Boyce, DPhil, assistant professor in health policy and management at University of Massachusetts Amherst, told Healio. “This was particularly pronounced in children and young people with newly diagnosed type 1 diabetes.”
Hartmann-Boyce and colleagues conducted a systematic review of the MEDLINE and OVID databases for articles comparing outcomes for people with diabetes during the COVID-19 pandemic vs. before the pandemic published from 2020 to June 7, 2023. Clinical outcomes assessed were mortality, hospital admissions, DKA, amputations, sight loss, emergency admissions, foot ulcer presentations, severe hypoglycemia and renal failure.
The findings were published in The Lancet Diabetes & Endocrinology.
Admissions, DKA rise for children
There were 138 publications assessed in the review, including 133 primary studies and five systematic reviews. Six studies examined all-cause mortality, of which five found an increase in mortality during the COVID-19 pandemic compared with before. Thirteen studies examined diabetes-related mortality, with all of them finding increases during the pandemic compared with pre-pandemic.
All-cause hospital admissions were examined in five studies. Three studies reported a decline in hospital admissions during the pandemic and two found no changes during the pandemic compared with before. Diabetes-related hospital admissions were assessed in 30 studies, with some studies showing increases and others showing decreases. Most studies analyzing diabetes-related hospital admissions for children, however, found increases during the pandemic, whereas most studies assessing diabetes-related hospital admissions among adults found no changes. Nine studies examined emergency hospital admissions. Findings were mixed, with four studies reporting a decrease during the pandemic, three studies reporting an increase and two studies finding no changes.
Four systematic reviews assessed DKA, of which three found DKA increased during the COVID-19 pandemic among children and people with new-onset type 1 diabetes compared with before the pandemic. There were also 69 primary studies assessing DKA. Of the 13 studies analyzing adults, most found no clear evidence of a difference in rates during the pandemic compared with before. Among 56 studies analyzing youths, 47 found DKA occurrence or severity increased during the pandemic.
“It was striking to see the stark increases in DKA and pediatric ICU admissions in children and young people,” Hartmann-Boyce said. “One potential cause of this could be delayed presentation in health care settings, whether with new-onset type 1 diabetes or with existing diabetes. We know that health care systems were under enormous pressure, and that many individuals were reticent to attend health care settings due to concerns about overburdening the system and about contracting COVID. This may have delayed treatment seeking and meant that when young people finally did present to health care settings, they were sicker than they would have been otherwise.”
Mixed data for amputation, sight loss
Findings were mixed for studies assessing amputations. Among nine studies that did not differentiate by amputation type, three studies found an increase in amputations during the pandemic, two found a decrease and four observed no difference. Among 12 studies assessing major amputations, nine found an increase during the pandemic. Of four studies on foot ulcers judged to be at lowest risk of bias, three found an increase during the pandemic compared with pre-pandemic. Data were mixed for sight loss, with three of six primary studies reporting an increase during the pandemic, two reporting no difference and one finding a decrease. A decrease in sight loss during the pandemic was also reported in a systematic review.
“These findings have implications for future pandemic planning, and for pandemic recovery,” Hartmann-Boyce said. “In planning for future pandemics, efforts should be made to ensure continuous access to diabetes medications and to reassure people with diabetes about accessing health care when they need it — including essential screenings, and what to do when signs of new-onset type 1 diabetes are detected. The negative impacts of the pandemic have been particularly pronounced within certain groups of people with diabetes, including those who use insulin, women, children and young people and people from less advantaged groups. Efforts should be made to prioritize screening and other catch-up diabetes services to make up for services missed during the pandemic.”
For more information:
Jamie Hartmann-Boyce, DPhil, can be reached at jhartmannboy@umass.edu.
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Hartmann-Boyce J, et al. Lancet Diabetes Endocrinol. 2024;doi:10.1016/S2213-8587(23)00351-0.
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