Lahn Valentina, Tittel Sascha R, Ohlenschläger Ute, Kamrath Clemens, Hammersen Johanna, Gellai Renata, Mönkemöller Kirsten, Dost Axel, Bartelt Heike, Holl Reinhard W
Department of Pediatrics, Altona Children's Hospital, Hamburg, Germany.
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
Pediatr Diabetes. 2025 May 15;2025:9903467. doi: 10.1155/pedi/9903467. eCollection 2025.
To investigate whether the remission period in type 1 diabetes, as measured by insulin-dose adjusted A1c (IDAA1C), was affected by the COVID-19 pandemic. Data from 7603 children and adolescents with type 1 diabetes from the prospective diabetes follow-up (DPV) registry were available. We compared two time periods of diabetes onset, 2020/2021 vs. 2018/2019. IDAA1C and remission prevalence (IDAA1c < 9%) were analyzed using logistic and linear regression models adjusted for age groups (0.5-<6, 6-<12, and 12-<18 years), sex, diabetic ketoacidosis (DKA) at onset, use of continuous glucose monitoring (CGM) systems, insulin pumps, sensor-augmented pumps (SAPs) or automated insulin delivery (AID) systems, BMI categories (<90. percentile of BMI, 90. -<97. percentile of BMI, 97. -<99.5 percentile of BMI, > = 99.5 percentile of BMI) and immigrant background. Data from three time periods were analyzed: 3-5 months, 6-10 months, and 11-13 months after diagnosis of type 1 diabetes. Compared to the prepandemic period, during the COVID-19 pandemic adjusted IDAA1C was significantly higher at 3-5 months after diagnosis (mean estimated differences 0.26 [95% confidence interval 0.17; 0.35], < 0.001), but not at 6-10 months and 11-13 months after diagnosis (mean estimated difference 0.08 [-0.01; 0.17], =0.07; and -0.03 [-0.12; 0.07], =0.60), reflecting a lower percentage of patients in remission at 3-5 months. Reasons may be changes in autoimmune progression during the pandemic, lack of physical activities, increased stress or psychological burden, or altered access to care with delayed diagnosis of diabetes. Underlying causes need to be evaluated in future studies.
为研究1型糖尿病的缓解期（通过胰岛素剂量调整糖化血红蛋白（IDAA1C）来衡量）是否受到新冠疫情的影响。我们获取了前瞻性糖尿病随访（DPV）登记处7603名1型糖尿病儿童和青少年的数据。我们比较了两个糖尿病发病时间段，即2020/2021年与2018/2019年。使用逻辑回归和线性回归模型分析IDAA1C和缓解患病率（IDAA1c＜9%），模型针对年龄组（0.5 - ＜6岁、6 - ＜12岁和12 - ＜18岁）、性别、发病时的糖尿病酮症酸中毒（DKA）、是否使用持续葡萄糖监测（CGM）系统、胰岛素泵、传感器增强泵（SAP）或自动胰岛素输送（AID）系统、BMI类别（BMI的＜90百分位数、90 - ＜97百分位数、97 - ＜99.5百分位数、≥99.5百分位数）以及移民背景进行了调整。分析了三个时间段的数据：1型糖尿病诊断后的3 - 5个月、6 - 10个月和11 - 13个月。与疫情前时期相比，在新冠疫情期间，诊断后3 - 5个月时调整后的IDAA1C显著更高（平均估计差异为0.26 [95%置信区间0.17；0.35]，P＜0.001），但在诊断后6 - 10个月和11 - 13个月时并非如此（平均估计差异为0.08 [-0.01；0.17]，P = 0.07；以及 -0.03 [-0.12；0.07]，P = 0.60），这反映出在3 - 5个月时缓解的患者比例较低。原因可能是疫情期间自身免疫进展的变化、缺乏体育活动、压力或心理负担增加，或者是糖尿病诊断延迟导致的就医机会改变。潜在原因需要在未来研究中进行评估。
