d'Annunzio Giuseppe, Bassi Marta, De Rose Elena Lucia, Lezzi Marilea, Minuto Nicola, Calevo Maria Grazia, Gaiero Alberto, Fichera Graziella, Borea Riccardo, Maghnie Mohamad
Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.
Front Clin Diabetes Healthc. 2022 Feb 24;3:846827. doi: 10.3389/fcdhc.2022.846827. eCollection 2022.
Diabetic ketoacidosis is the most severe metabolic derangement due to prolonged insulin deficiency as in type 1 diabetes. Diabetic ketoacidosis, a life-threatening condition, is often diagnosed late. A timely diagnosis is mandatory to prevent its consequences, mainly neurological. The COVID-19 pandemic and lockdown have reduced the availability of medical care and access to hospitals. The aim of our retrospective study was to compare the frequency of ketoacidosis at the diagnosis of type 1 diabetes between the lockdown-post lockdown period and the previous two calendar years, in order to evaluate the impact of the COVID-19 pandemic.
We retrospectively assessed the clinical and metabolic data at the diagnosis of type 1 diabetes in children in the Liguria Region during 3 different time periods: calendar year 2018 (Period A), calendar year 2019 until February 23,2020 (Period B) and from February 24, 2020 onwards to March 31, 2021 (Period C).
We analyzed 99 patients with newly-diagnosed T1DM from 01/01/2018 to 31/03/2021. Briefly, a younger age at diagnosis of T1DM was observed in Period 2 compared to Period 1 (p = 0.03). The frequency of DKA at clinical onset of T1DM was similar in Period A (32.3%) and Period B (37.5%), while it significantly increased in Period C (61.1%) compared to Period B (37.5%) (p = 0.03). PH values were similar in Period A (7.29 ± 0.14) and Period B (7.27 ± 0.17), while they were significantly lower in Period C (7.21 ± 0.17) compared to Period B (p = 0.04).
An increase in the frequency of diabetic ketoacidosis has been documented in newly diagnosed pediatric patients in the Liguria Region during and after the lockdown period compared to previous calendar years. This increase could have been caused by the delay in diagnosis following the restrictions imposed by the lockdown with consequently reduced access to health care facilities. More information on the risks of ketoacidosis is desirable by means of social and medical awareness campaigns.
糖尿病酮症酸中毒是1型糖尿病中由于长期胰岛素缺乏导致的最严重的代谢紊乱。糖尿病酮症酸中毒是一种危及生命的疾病，常常诊断延迟。及时诊断对于预防其后果（主要是神经系统后果）至关重要。新冠疫情及封锁措施减少了医疗服务的可及性以及就医机会。我们这项回顾性研究的目的是比较封锁后时期与前两个日历年1型糖尿病诊断时酮症酸中毒的发生率，以评估新冠疫情的影响。
我们回顾性评估了利古里亚地区儿童在3个不同时间段1型糖尿病诊断时的临床和代谢数据：2018日历年（A期）、2019日历年至2020年2月23日（B期）以及2020年2月24日起至2021年3月31日（C期）。
我们分析了2018年1月1日至2021年3月31日期间99例新诊断的1型糖尿病患者。简而言之，与第1期相比，第2期1型糖尿病诊断时年龄更小（p = 0.03）。1型糖尿病临床发病时糖尿病酮症酸中毒的发生率在A期（32.3%）和B期（37.5%）相似，而与B期（37.5%）相比，C期显著增加（61.1%）（p = 0.03）。pH值在A期（7.29±0.14）和B期（7.27±0.17）相似，而与B期相比，C期显著更低（7.21±0.17）（p = 0.04）。
与之前的日历年相比，利古里亚地区封锁期间及之后新诊断的儿科患者中糖尿病酮症酸中毒的发生率有所增加。这种增加可能是由于封锁措施导致诊断延迟，进而减少了获得医疗保健设施的机会。需要通过社会和医疗宣传活动提供更多关于酮症酸中毒风险的信息。
