A significant increase in diabetic ketoacidosis (CDA) among other young people at the time of diagnosis of type 1 diabetes occurred in Germany with the discontinuation of COVID-19, which further aggravated a trend that was already happening in several countries, adding Germany and the United States – before the pandemic.
The new knowledge comes from the German Registry for Prospective Diabetes Control of 532 young people and adolescents with type 1 diabetes which gave the impression between 13 March 2020, when the maximum of kindergartens and schools in Germany were closed due to the pandemic, and on 13 May 2020.
The findings were published online on July 20 at JAMA through Clemens Kamrath, MD, pediatric endocrinologist at the Center for Child and Adolescent Medicine at Justus Liebig University, Giessen, Germany, and colleagues.
The proportion of other young people with ACD at the time of diabetes diagnosis in Germany in 2020, at 44.7%, almost doubled to the same time in the last 2 years, to 24.5% in 2019 and 24.1% in 2018 (both P
Severe CDA rates have also increased, with the largest increases in children under 6 years of age.
“At the beginning of the pandemic, many clinics disseminated data through social media asking patients not to go unnecessarily to the clinic or with symptoms of COVID-19 infection. However, this data was also misunderstood and some parents did not know whether or not to move to clinics or medical offices. Of course, many parents were also concerned about the infection when they went to the doctor,” Kamrath told Medscape Medical News.
Although researchers have evaluated any other knowledge since mid-May, “we received feedback from many diabetes centers that a maximum rate of ketoacidosis remains icedArray. Communication wants to improve,” he emphasized.
In addition to the overall accumulation in the CAD rate (defined as pH
Children under the age of 6 had the highest rate of diabetic ketoacidosis in 2020, with 51.9% compared to 18.4% in 2019 (P
Early rates of CDA for type 1 diabetes had increased even before the pandemic in Germany and elsewhere, according to the knowledge published in May (Diabetologia.2020; 63: 1530-41). The authors were a foreign team and come with a co-author of the existing study, Reinhard W. Holl, MD, PhD, Ulm University and the German Diabetes Research Centre, Munich-Neuherberg.
Diabetologia evaluated temporary trends in CDA by diagnosing pediatric type 1 diabetes between 2006 and 2016 in thirteen countries on 3 continents.
There is a significant overall accumulation in CDA of 1.8% during the examined era (PArray001), specifically in Australia (P-026), Germany (P-002) and the United States (P
In the United States, the proportion of other young people with CDA at the time of diagnosis of type 1 diabetes in 2016, at 40.6%, was almost as high as the pandemic ratio in Germany and had a higher proportion of about 2% consistent with the year. since 2010 (P -0.01).
This U.S. data, from SEARCH for Diabetes in Youth at five sites, was presented in September 2019 at the 2019 annual european meeting of the European Association for the Study of Diabetes (EASD) through Elizabeth T.Jensen, PhD, Associate Professor of Epidemiology at Wake Forest School of Medicine, Winston-Salem, South Carolina.
When asked to comment on the new knowledge of the pandemic era in Germany, Jensen told Medscape Medical News that the most recent report “further supports this claim that attention delays may simply be one thing in what we observed in the United States before COVID-19. Matrix “
However, he warned, “there is significant heterogeneity between countries in what has been reported, due in component to the underlying population, but also to socioeconomic points and, as the authors point out, they will most likely care.”
“In our own study, we hypothesized that the relatively high proportion of CDA at the time of diagnosis is possibly due to delays in seeking attention, in all likelihood due to our fitness insurance landscape, this express assumption is not verifiable with the knowledge we had.
When asked what can be done to facilitate a prior diagnosis of type 1 diabetes prior to the progression of diabetic ketoacidosis, Kamrath said: “Any impediment that may delay presentation or increase effort for a presentation to the circle of family members, physician or clinic should be remote.
“Free access to high-pitched presentations will have to be guaranteed. Even without a pandemic, the ratio of ketoacidosis is too high. Prevention through schooling or antibody detection can simply decrease the rate, even after COVID-19.”
Jensen said: “Certainly, this is a vital concern and, where possible, we deserve to review to dispel the considerations of patients seeking number one care while taking precautions to mitigate hazards for patients seeking care.”
“Providing and educating patients about the option of accessing care through telehealth visits can help circumvent some of the additional threats of this period,” he added.
She also observed: “It will be attractive to see what happens with the construction of telehealth visits and whether this will increase to care for some patients who otherwise, even before COVID-19, had difficulty in care.
But “it remains to be noted whether this will be the threat of late attention in new-evolving type 1 diabetes,” he concluded.
Kamrath and Jensen reported any applicable monetary relationships.
Jama. Published July 20, 2020. Full text
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Medical News from Medscape © 2020 WebMD, LLC
Independent Editor, Medscape Disclosure: Miriam E. Tucker revealed any applicable monetary relationship.
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