Department of Endocrinology, University Hospital of Farhat Hached, Sousse, Tunisia.
University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia.
Front Endocrinol (Lausanne). 2023 Jul 26;14:1234256. doi: 10.3389/fendo.2023.1234256. eCollection 2023.
Reports around the world indicate that COVID-19 pandemic may be contributing to an increase in the incidence of new onset diabetic ketoacidosis (DKA). This has yet to be studied in Africa. We aimed to compare the incidence trend of new onset DKA before and during the COVID-19 pandemic, with a focus on the type of diabetes mellitus (DM).Materials and methodsThis was a cross sectional analytical study, over a 4-year period, between March 2018 until February 2022 conducted in the referral center: diabetology department of university hospital Farhat Hached Sousse, Tunisia. The study population included patients hospitalized for new onset DKA divided in two groups: G1: before COVID-19 pandemic and G2: during COVID-19 pandemic. Patients younger than 14, new onset DM not presenting with DKA, other types of diabetes (monogenic, secondary or pancreatic diabetes) were not included. A statistical analysis of the monthly incidence trend was conducted using the Jointpoint software providing the average monthly percentage of change (AMPC).
a total of 340 patients were included:137 registered before the pandemic and 203 during the pandemic, representing a 48.17% increase. The mean monthly incidence of new onset DKA during COVID-19 pandemic was statistically higher than that before COVID-19 pandemic (8.42 ± 4.87 vs 5.75 ± 4.29 DKA per month) (p=0.049). The temporal trend of DKA during the 4-year study showed a significant upward trend with a change in AMPC of +0.2% (p=0.037). The incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) increased by 50% and 44% respectively during COVID-19 pandemic. Anti-glutamic acid decarboxylase (anti-GAD) antibodies' titers significantly increased in G2 compared with G1 (median of 330[Q1-Q3]=[58.5-1795]vs 92.5[Q1-Q3]=[22.5-1074] respectively)(p=0.021).
The incidence trend of DKA showed an increase during the COVID-19 pandemic along with an increase of T1D and T2D implying that the pandemic may have been the underlying factor of this upward trend.
世界各地的报告表明，COVID-19 大流行可能导致新发糖尿病酮症酸中毒 (DKA) 的发病率上升。这在非洲尚未得到研究。我们旨在比较 COVID-19 大流行前后新发 DKA 的发病率趋势，重点关注糖尿病类型。
这是一项在突尼斯 Farhat Hached 苏塞大学医院内分泌科进行的 4 年期间的横断面分析研究，时间为 2018 年 3 月至 2022 年 2 月。研究人群包括因新发 DKA 住院的患者，分为两组：G1：COVID-19 大流行前，G2：COVID-19 大流行期间。未纳入年龄小于 14 岁、无 DKA 表现的新发 DM 患者、其他类型糖尿病（单基因、继发性或胰腺性糖尿病）患者。使用 Jointpoint 软件对每月发病率趋势进行统计学分析，提供平均每月百分比变化 (AMPC)。
共纳入 340 例患者：137 例登记在大流行前，203 例登记在大流行期间，增长 48.17%。COVID-19 大流行期间新发 DKA 的平均每月发病率明显高于 COVID-19 大流行前（每月 8.42 ± 4.87 vs 5.75 ± 4.29 DKA）（p=0.049）。在 4 年的研究期间，DKA 的时间趋势呈显著上升趋势，AMP 变化为+0.2%（p=0.037）。COVID-19 大流行期间，1 型糖尿病 (T1D) 和 2 型糖尿病 (T2D) 的发病率分别增加了 50%和 44%。与 G1 相比，G2 中谷氨酸脱羧酶 (anti-GAD) 抗体滴度显著增加（中位数分别为 330[Q1-Q3]=[58.5-1795]和 92.5[Q1-Q3]=[22.5-1074]）（p=0.021）。
DKA 的发病率趋势在 COVID-19 大流行期间呈上升趋势，同时 T1D 和 T2D 的发病率也呈上升趋势，这表明大流行可能是这一上升趋势的潜在因素。
