Diabetes and COVID-19: #ISPAD2021-S1E1

 

As a #dedocvoice scholar (for the 3rd time) since 2020, I had the opportunity to attend the most extraordinary 47th ISPAD Annual Conference (October 13-15, 2021). I'm forever grateful to #dedoc° for the amazing opportunities not only to attend but to speak. This blog will focus on the impact of COVID-19 on Diabetes (those at risk and people living with diabetes already), from the ePosters presented during the conference. 

COVID19 and the impact on youth onset type 2 diabetes new diagnoses and severity @Sean DeLacey

Initial studies of pediatric diabetes and COVID-19 focused on type 1 diabetes with some initial reports showing an increase in youth onset type 2 diabetes (T2D). New diagnoses of T2D increased during the COVID-19 pandemic; New diagnoses increased disproportionately in the non-Hispanic Black population; HbA1C values at diagnosis increased, but rates of acidosis and hyperosmolarity did not; Clinical COVID infection was uncommon among those with a new diagnosis of Type 2 diabetes; The findings displayed the significant effect of the COVID-19 pandemic on youth, specifically Black youth; and given the lack of COVID-19 positivity, the increase may be tied to social-distancing practices and behavioral changes.

Concomitant presence of COVID-19 infection and inaugural diabetic ketoacidosis in children and adolescents @Christina Maria Mihai

The COVID-19 pandemic, which has left its mark all over the world, has led to a decrease in the addressability to health care professionals, due to people's fear of becoming infected with COVID-19. This delays a correct diagnosis that can have life-threatening consequences. Due to the general fear of appearing in a hospital during the COVID-19 pandemic, there are delays in the diagnosis of life-threatening conditions, such as ketoacidosis. The link between SARS-CoV2 infection and type 1 diabetes in children and adolescents remains unknown and further studies are needed to gather more data.

The usefulness of serological antibodies assays to better evaluate the prevalence of SARS-CoV-2 infection in youths with type 1 diabetes @Barbara Predieri

In youths with type 1 diabetes (T1D), diabetic ketoacidosis (DKA) at onset increased during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In adults, diabetes was identified as risk factor for severe symptoms and hospitalization with the coronavirus disease-2019 (COVID-19). Using seroprevalence of antibodies, it was found that an increased prevalence of SARS-CoV-2 infection that had no impact on glycemic control and acute complications. Asymptomatic subjects were 43%, while fever, headache, anosmia/ageusia were the most common clinical characteristics. Therefore, data suggest that serological assay is useful for diagnosing previous SARS-CoV-2 infection and could be used to reconstruct the disease prevalence.

The effect of Telemedicine on the management of type 1 diabetes during the COVID-19 Pandemic @Banshi Saboo

Telemedicine is not unusual when treating patients with type 1 diabetes. However, the pandemic has reinforced the healthcare professional on its usage. The frequent telemedicine system reduces the indexes of HbA1c and rate of hypo and lipo in patients with type 1 diabetes whereas there is an increase in indexes of HbA1c, hypo n lipo. Hence, it can be said that type 1 diabetes is a condition that demands continuous care.

Increase in newly diagnosed type 1 diabetes among pediatric and adolescent patients during the COVID;19 pandemic @Risa M Wolf

An increase in newly diagnosed type 1 diabetes (T1D) has been posited during the COVID-19 pandemic, but data have been conflicting. It was found that an increase in newly diagnosed T1D and a greater proportion of newly diagnosed T1D patients presenting in DKA at diagnosis during the COVID-19 pandemic compared to the prior year. However, future longitudinal studies are needed to confirm these findings with population-level data and determine the long-term impact of COVID-19 on diabetes trends.

Factors associated with hospitalization in youths and young adults with type 2 diabetes and COVID-19 infection @Erin Tallon

Considerable research has addressed the impact and increased severity of coronavirus disease 2019 (COVID-19) in adult patients with type 2 diabetes (T2D).  However, findings from older adult patients cannot be generalized to affected children and young adults. It was therefore concluded that male gender, increased HbA1c, and increased BMI are associated with hospitalization in youths and young adults with T2D and COVID-19 infection. Above all, further study is needed to identify targeted interventions to prevent hospitalization in youths and young adults with T2D.

Diabetic ketoacidosis rates rose among patients with type 1 diabetes during US COVID-19 peaks with the highest burden on non-Hispanic blacks @Andrew R. Lavik

The COVID-19 pandemic has had far-reaching consequences for individuals with type 1 diabetes (T1D) and has laid bare inequities in health care. DKA rates rose among patients with T1D during US COVID-19 Waves 1 and 2, with the highest rates among NH Blacks. These findings highlight the urgent need for improved strategies to decrease the risk of DKA in individuals with T1D under pandemic conditions, especially among populations most affected by health inequities. 

The impact of COVID-19 on diabetes management for adolescents with T1D and their parents @Joyce Yi-Frazier

For families with type 1 diabetes (T1D), anxiety from the COVID-19 pandemic may be elevated due to the potential for increased vulnerability. Discussing how the pandemic impacted families’ T1D management may be an important focus for clinicians, especially for adolescents with above-target A1C. Strategies to improve resilience for ongoing and future stress may be of value.

Metabolic control and cardiovascular (CV) risk factors in adolescents with T2DM in the pandemic year @Stefano Zucchini

Lockdown due to pandemic has caused an increase in BMI and CV risk factors in obese patients (pts), while pts with T1DM showed greater glucose stability with unchanged HbA1c levels.  Obese adolescents with T2DM may have been negatively affected by social restrictions. It was concluded that the long period of social restrictions does not seem to have affected metabolic control and CV risk factors in our adolescents with T2DM followed in the Italian centres of the ISPED. Metabolic control was apparently more irregular in male patients compared to that of female patients. 

Association between covid exposure, impact, and distress and pediatric diabetes quality of life in youth with type 1 diabetes @Erin Corby

The COVID-19 pandemic has caused significant disruption to normal day-to-day life, including physical, mental, and social health. The impact of COVID-19 on quality of life in youth with type 1 diabetes (T1D) is not known. Despite relatively low COVID exposure, families of youth with T1D have been negatively impacted by the pandemic. Pediatric quality of life was significantly lower with increased COVID exposure, impact, and distress, highlighting the importance for health care providers to consider the psychosocial impact of the COVID pandemic on this population.

Diabetes-related distress in children with type 1 diabetes before and during the COVID-19 lockdown in spring 2020 @Beata Mianowska

Diabetes distress (DD) is contributing to psychological burden in children with type 1 diabetes (T1D) and in their parents. DD might be influenced by additional stressors such as the COVID-19 pandemic. The COVID-19-related lockdown was associated with a decrease in DD in teens with T1D, while no significant change in DD was observed in children or parents. DD decrease in teens during the pandemic should attract attention to the potential “rebound” of DD related to return to regular on-site school routine.

Impact of a pandemic on profile and outcome of patients with new-onset Type 1 diabetes @Fathima Mohamed Haniffa

The COVID-19 infection which started in Wuhan China in 2019 spread to the United Kingdom in 2020. The pandemic had a profound impact on how care was delivered with the increased use of virtual platforms for clinics and ward reviews. It was noted that an increase in the number of children presenting to our centre with nT1DM. Although patients with nT1DM were more likely to present in DKA during the pandemic, there appears to be no difference in short-term glycaemic outcomes as the diabetes team was able to adapt to supporting patients both virtually and in-person during the pandemic. An increase in % presenting DKA during the pandemic has been previously reported and may be due to delays in seeking medical help by families.

Factors associated with hospitalization in youths and young adults with type 1 diabetes and COVID-19 infection @Erin Tallon

Numerous studies have investigated the impact and increased severity of coronavirus disease 2019 (COVID-19) in adult patients with diabetes.  However, findings from older adult patients cannot be generalized to affected children and young adults. In patients who were not in DKA, higher ECS was associated with hospitalization, while public insurance was significantly associated with DKA for patients who were in DKA.

How young adults with type 1 diabetes responded to the beginning of the COVID-19 pandemic: A qualitative thematic analysis @Rachel Wasserman

The COVID-19 pandemic is an unprecedented stressor that caused a major disruption in social, economic, educational, and health care systems. Reactions to the COVID-19 pandemic varied widely among YA with T1D. Having a better understanding of the challenges that YA with T1D faced early in the pandemic may assist healthcare providers in providing ongoing support.

Health-related quality of life and metabolic control in young patients with type 1 diabetes and in their parents before and after the COVID-19 lockdown @Barbara Predieri

Since the beginning of the COVID-19 pandemic, concerns for consequences in patients with type 1 diabetes (T1D) were raised. During COVID-19 pandemic-related lockdown the D-HRQOL did not change in children and adolescents with T1D and their parents. Our data may be possibly related to staying at home, making diabetes management easier, and also allowing the maintenance of good glycemic control without acute complications.

Pulmonary mucormycosis and vascular complications in the setting of new-onset diabetes mellitus and COVID-19 @Daniela Aguilar Abisad

We present the case of a 17-year old female who had an unusual course of pulmonary vascular complications in the setting of new-onset type 1 diabetes mellitus and Covid-19 infection. While poorly controlled DM is known to be a pro-inflammatory, pro-coagulant, and immunosuppressive condition, SARS-Cov-2 potentiates endothelial damage, suggesting a possible synergic effect in our patient’s unique presentation. While sino-orbital mucormycosis is commonly seen in adults with DM, in children, the infection affects only about 15% with only scarce case reports of pulmonary involvement. Additional studies are needed to understand the synergy of a severe DM presentation with COVID-19 and its potential respiratory and systemic complications.

Bridging the needs of adolescent diabetes care during coronavirus disease 2019: a nurse-led telehealth initiative @Soo Ting Lim

COVID-19 pandemic has changed many lifestyle habits and has been detrimental for children/ teenagers with diabetes, including sedentary home-based learning with dietary changes that demanded insulin adjustments. Fear and anxiety to attend clinic visits by parents/children call for a nurse-led telehealth initiative to ensure uninterrupted diabetes care for adolescents. Pandemics pose unique challenges to health care delivery and while the health systems are re-configured, telehealth has served to bridge the need for continuity of care especially in the management of adolescents with T1DM.

Higher rates of diabetic ketoacidosis (DKA) and admission to the pediatric intensive care unit (PICU) among newly diagnosed children with type 1 diabetes in Kuwait during the COVID 19 pandemic @Dalia Al-Abdulrazzaq

The COVID-19 pandemic might have a multifaceted effect on children with Type 1 Diabetes (T1D), either directly through infection itself or indirectly due to measures implemented by health authorities to control the pandemic. High rates of DKA at presentation and admission to PICU in incident T1D cases during the COVID-19 pandemic warrant further studies and effective mitigation efforts through increasing awareness, early detection, and timely intervention.

"It just kind of feels like a different world now:” Stress, coping, and resilience for adolescents with type 1 diabetes (T1D) in the era of COVID-19 @Maeve O’Donnell

The COVID-19 pandemic has been a major stressor for adolescents with T1D, a group already at risk for elevated mood concerns. Adolescents’ responses underscore the pervasive stress impact of COVID-19 across nearly all major life domains. Coping strategies align with theory and suggest likely resilience in the face of pervasive stress. Given the elevated risks for distress in this population, there is a need for interventions to offer diverse stress management tools and resilience resources for adolescents with T1D. 

Management of diabetic ketoacidosis (DKA) in children during COVID-19 pandemic at a tertiary care center @Siham Rouf

Covid 19 pandemic significantly influenced the diagnosis of type 1 diabetes which entails a special concern. The increased prevalence of severe DKA nowadays, whether partly related to delayed hospital admission or related to the effect of COVID-19 is a real challenge in managing patients. Telemedicine seems to be an effective approach for the management of patients with New-onset T1D

The strong association between health insurance type and adverse outcomes for pediatric and adolescent patients with type 1 diabetes and COVID-19; Data from the T1D Exchange COVID Registry @Saketh Rompicherla

Health insurance coverage type differs significantly by socioeconomic status and racial groups in the United States. There is limited data on the association between insurance and the risk of adverse outcomes for patients with pre-existing T1D and COVID19. T1D Exchange data reveals a high rate of hospitalization and DKA among children and adolescents with T1D and COVID19 with public health insurance despite controlling for other potential confounders. This underscores that those on public health insurance are more vulnerable to adverse health outcomes during the COVID19 pandemic.

New-onset diabetes in a boy with the multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection @ Marija Požgaj Šepec

During the past year, COVID-19 infection was recognized as a potential trigger for new-onset diabetes in children. A rare but severe complication of COVID-19 infection in children and adolescents is a multisystem inflammatory syndrome in children (MIS-C). In the pediatric population, inflammatory syndromes like MIS-C can raise the risk for diabetes development or presentation. Therefore, it is important to monitor glycemia during the course of MIS-C and also during post-inflammatory follow-up.

#docday° has been promoted!

This year at ISPAD, our usual #docday° was part of the official conference program, reaching a much broader audience. We presented #dedoc° and the #dedoc° voices, shared news about the latest collaboration with The BMJ, and discussed the issues that have always been central to #dedoc°, #docday°, and the Patient Voice. Find the link below and learn more here

The #dedoc° voices scholarship program grants diabetes patient advocates free access to the world's most prestigious diabetes conferences: ATTDEASD, and ISPAD. It provides a dedicated platform for PwD, HCPs, researchers, and industry to meet and exchange: #docday°, #docnight°, our #dedoc° voices networking events, and our exclusive DOClab consultancy sessions. Learn more about it here

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