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在 COVID-19 大流行封锁期间,1 型糖尿病发病时严重糖尿病酮症酸中毒的频率增加:一项观察性队列研究。

Increased frequency of severe diabetic ketoacidosis at type 1 diabetes onset among children during COVID-19 pandemic lockdown: an observational cohort study.

机构信息

Clinical Department of Pediatric Diabetology and Pediatrics, UCK WUM DSK, Medical University of Warsaw, Poland.

Department of Pediatrics, Medical University of Warsaw, Poland.

出版信息

Pediatr Endocrinol Diabetes Metab. 2020;26(4):167-175. doi: 10.5114/pedm.2020.101003.

Abstract

INTRODUCTION

On March 11, 2020 the WHO announced a coronavirus disease 2019 (COVID-19) pandemic. Lockdown restrictions, compromised access to medical care and fear of potential exposure to SARS-CoV-2 have forced patients with non-COVID-19 illnesses such as type 1 diabetes (T1D) to stay home. This situation can lead to delay in T1D diagnosis and insulin treatment resulting in rapid progression to diabetic ketoacidosis (DKA) and therefore increased risk of complications and death.  .

AIM

The aim of this study was to evaluate the frequency and severity of DKA at the onset of T1D in children diagnosed in our department during COVID-19 pandemic lockdown from March 2020 till May 2020 in comparison to corresponding period of the previous year. .

MATERIAL AND METHODS

We collected data of children with newly diagnosed T1D. DKA was defined according to ISPAD guidelines. .

RESULTS

The study cohort comprised 34 children in group 2020 and 52 in group 2019 with an average age 9.90 ±4.9 vs. 9.59±4.7 years with mean HbA1c 12.9 ±2.4 vs. 11.5 ±2.2%, respectively. The incidence of DKA was higher by 12% in group 2020 vs. 2019 (52.94% vs 40.38%; p = 0.276).  Regarding the DKA severity (2020 vs. 2019) 32.35% vs. 11.54% were severe (p = 0.026), 17.65 vs. 13% were moderate (p = 0.759), and 2.94 vs. 15.38% were mild (p = 0.081). None of the analyzed patients were COVID-19 positive.

CONCLUSIONS

During the COVID-19 pandemic lockdown changes in society and health care system, the DKA rate has increased by 12 percentage points with more severe cases noted in children with newly diagnosed T1D. Regular education of the whole society about the symptoms of diabetes could contribute to faster diagnosis of T1D and reduction of DKA prevalence. .

摘要

简介

2020 年 3 月 11 日,世界卫生组织宣布 2019 冠状病毒病(COVID-19)大流行。封锁限制、医疗服务获取受限以及对潜在 SARS-CoV-2 暴露的恐惧,迫使 1 型糖尿病(T1D)等非 COVID-19 疾病患者留在家中。这种情况可能导致 T1D 诊断和胰岛素治疗的延迟,导致糖尿病酮症酸中毒(DKA)迅速进展,从而增加并发症和死亡的风险。目的:本研究旨在评估与前一年同期相比,2020 年 3 月至 2020 年 5 月 COVID-19 大流行封锁期间在我科诊断的儿童 T1D 发病时 DKA 的频率和严重程度。材料与方法:我们收集了新诊断为 T1D 的儿童数据。DKA 根据 ISPAD 指南定义。结果:研究队列包括 2020 年组的 34 名儿童和 2019 年组的 52 名儿童,平均年龄分别为 9.90±4.9 岁和 9.59±4.7 岁,平均 HbA1c 分别为 12.9±2.4%和 11.5±2.2%。2020 年组 DKA 的发生率比 2019 年组高 12%(52.94%比 40.38%;p=0.276)。关于 DKA 严重程度(2020 年与 2019 年),32.35%比 11.54%为重度(p=0.026),17.65%比 13%为中度(p=0.759),2.94%比 15.38%为轻度(p=0.081)。分析的患者均未检测到 COVID-19 阳性。结论:在 COVID-19 大流行封锁期间,社会和医疗保健系统发生变化,新诊断的 T1D 儿童 DKA 发生率增加了 12 个百分点,且更严重。全社会对糖尿病症状的定期教育有助于更快地诊断 T1D,降低 DKA 的发生率。

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