Araştırma Makalesi
Evaluation of the Presentation of Newly Diagnosed Type 1 Diabetes Mellitus in Children During and After the COVID-19 Pandemic
Öz
Background: The COVID-19 pandemic has been a global health problem with high morbidity and mortality. In this study, it was aimed to compare the clinical and laboratory findings of patients diagnosed with type 1 diabetes(T1D) during the pandemic and after the pandemic.
Method: This is a 30-month, single-center, cross-sectional study. Between October 2020 and December 2021 was defined as the pandemic period, and between January 2022 and March 2023 as the post-pandemic period. The clinical and laboratory parameters of the newly diagnosed T1D patients who applied in these two time periods were compared.
Results: While 87 patients were diagnosed during the pandemic period, 86 patients were diagnosed during the post-pandemic period. The rate of male patients diagnosed during the pandemic period was significantly higher (56%, 36%, respectively, p=0.007). Anti-islet Cell antibody (ICA) positivity was statistically significantly higher in those diagnosed during the pandemic period. (52.6%, 18.6%, respectively, p<0.001). There was no difference between the groups in terms of hemoglobin A1C, thyroid autoantibodies and tissue transglutaminase antibodies (p>0.05).C peptide levels were significantly lower in those diagnosed during the pandemic period (0.39±0.4, 0.63±0.6, respectively, p=0.021). Admissions with severe acidosis were more common during the pandemic than those admitted after the pandemic (29.9%, 16.3%, respectively, p=0.151).
Conclusions: The numbers of children with T1D newly diagnosed in a secondary health center were similar during and after the pandemic. In the pandemic period, admissions with autoantibody positivity, low C-peptide and severe acidosis were more common.
Anahtar Kelimeler
Etik Beyan
Karar No:2023/01 (18.1.2023 tarihinde) Gaziantep Üniversitesi Tıp Fakültesi Etik kurul biriminden onay alınmıştır.
Kaynakça
- Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71–6.
- Republic of Turkish Ministry of Health Covid-19 Information page. General Coronavirus Table. Available from: https://covid19.saglik.gov.tr/EN-69532/general-coronavirus-table.html.
- Rabbone I, Schiaffini R, Cherubini V, Maffeis C, Scaramuzza A. Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children? Diabetes Care 2020;43:2870–2.
- Ho J, Rosolowsky E, Pacaud D, Huang C, Lemay JA, Brockman N, et al. Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic. Pediatr Diabetes 2021; 22:552–7.
- Orhan Kılıç B, Kılıç S, Gül Ateş E. Vitamin D Status in Turkish Children During the Covid-19 Pandemic; A Single Center Experience. Genel Tıp Derg. 2023;33(4):390-3.
- Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al.ISPAD Clinical Practice Consensus Guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;27(19 Suppl):155–77.
- https://data.tuik.gov.tr/Kategori/GetKategori?p=nufus-ve-demografi-109&dil=1
- Republic of Turkey Ministry of Health Covid 19 Vaccination information platform. Available from: https://covid19asi.saglik.gov.tr/?_Dil=2
- Jalilova A, Ata A, Demir G, Işıklar H, Atik Altınok Y, Özen S, Darcan Ş, Gökşen D. The Effect of the SARS-CoV-2 Pandemic on Presentation with Diabetic Ketoacidosis in Children with New Onset Type 1 Diabetes Mellitus. J Clin Res Pediatr Endocrinol. 2023 Aug 23;15(3):264-267.
- Rewers M, Ludvigsson J. Environmental risk factors for type 1 diabetes. Lancet 2016;387:2340–8.
- Karavanaki K, Tsoka E, Liacopoulou M, Karayianni C, Petrou V, Pippidou E, et al. Psychological stress as a factor potentially contributing to the pathogenesis of Type 1 diabetes mellitus. J Endocrinol Invest 2008;31:406–15.
- Kamrath C., Rosenbauer J., Eckert A.J., Siedler K., Bartelt H., Klose D., et al. Incidence of type 1 diabetes in children and adolescents during the Covid-19 pandemic in Germany: results From the DPV Registry. Diabetes Care. 2022;45:1762‑71
- Reschke F., Lanzinger S., Herczeg V., Prahalad P., Schiaffini R., Mul D., et al. The Covid-19 pandemic affects seasonality, with increasing cases of new-onset type 1 diabetes in children, from the worldwide SWEET Registry. Diabetes Care. 2022
- McKeigue P.M., McGurnaghan S., Blackbourn L., Bath L.E., McAllister D.A., Caparrotta T.M., et al. Relation of incident type 1 diabetes to recent Covid-19 infection: cohort study using e-health record linkage in Scotland. Diabetes Care. 2022
- Birkebaek N.H., Kamrath C., Grimsmann J.M., Aakesson K., Cherubini V., Dovc K., et al. Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries. Lancet Diabetes Endocrinol. 2022 S2213-8587(22)00246-7.
- Fierabracci A, Arena A, Rossi P. COVID-19: A Review on Diagnosis, Treatment, and Prophylaxis. Int J Mol Sci. 2020;21:5145. doi: 10.3390/ijms21145145
- Schiaffini R, Campana A, Deodati A, Peschiaroli E, Lanzillotta MF, Fierabracci A. SARS-CoV-2 infection as possible downstream disease precipitator in autoantibody-positive insulin-dependent diabetes mellitus: a case report. Ital J Pediatr. 2022 Feb 23;48(1):33
- Pascolini S, Vannini A, Deleonardi G, Ciordinik M, Sensoli A, Carletti I, et al. COVID-19 and immunological dysregulation: can autoantibodies be useful? Clin Transl Sci 2021;14:502–8.
- Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020;395:1771–8.
- Chang, R. et al. Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study. eClinicalMedicine 56, 101783 (2023).
- Falko Tesch, Franz Ehm, Annika Vivirito, Danny Wende et al. Incident autoimmune diseases in association with a SARS-CoV-2 infection: A matched cohort study. medRxiv 2023.01.25.2328501
- Lania A, Sandri MT, Cellini M, Mirani M, Lavezzi E, Mazziotti G.Thyrotoxicosis in patients with COVID-19: the THYRCOV study. Eur J Endocrinol 2020;183:381–7.
- Tee LY, Harjanto S, Rosario BH. COVID-19 complicated by Hashimoto’s thyroiditis. Singapore Med J 2021;62:265.
- Schiaffini R, Campana A, Deodati A, Peschiaroli E, Lanzillotta MF, Fierabracci A. SARS-CoV-2 infection as possible downstream disease precipitator in autoantibody-positive insulin-dependent diabetes mellitus: a case report. Ital J Pediatr. 2022 Feb 23;48(1):33.
- Cabrera-Rode E, Sarmiento L, Tiberti C, Molina G, Barrios J, Hernández D, et al. Type 1 diabetes islet associated antibodies in subjects infected by echovirus 16. Diabetologia 2003;46:1348–53.
- Kulmala P, Savola K, Reijonen H, Veijola R, Vähäsalo P, Karjalainen J, et al. Genetic markers, humoral autoimmunity, and prediction of type 1 diabetes in siblings of affected children. Childhood diabetes in Finland study group. Diabetes 2000;49:48–58.
- Knip M. Prediction and prevention of type 1 diabetes. Acta Paediatr 1998;425:54–62.
- Sepa A, Wahlberg J, Vaarala O, Frodi A, Ludvigsson J. Psychological stress may induce diabetes-related autoimmunity in infancy. Diabetes Care 2005;28:290–5.
- Ardicli D, Kandemir N, Alikasifoglu A, Ozon A, Gonc N. Clinical characteristics of type 1 diabetes over a 40 year period in Turkey: secular trend towards earlier age of onset. J Pediatr Endocrinol Metab. 2014 Jul;27(7-8):635-41.
- Jamiołkowska-Sztabkowska M, Głowińska-Olszewska B, Bossowski A. C-peptide and residual β-cell function in pediatric diabetes - state of the art. Pediatr Endocrinol Diabetes Metab. 2021;27(2):123-133
- Maddaloni E, Cavallari I, Napoli N, Conte C. Vitamin D and Diabetes Mellitus. Front Horm Res. 2018;50:161-176.
- Bouter KP, Diepersloot RJ, Wismans PJ, Gmelig Meyling FH, Hoekstra JB, Heijtink RA, van Hattum J. Humoral immune response to a yeast-derived hepatitis B vaccine in patients with type 1 diabetes mellitus. Diabet Med. 1992 Jan-Feb;9(1):66-9.
- Cömlek FÖ, Sönmez G. Management Difficulties in the Coexistence of Covid-19 Infection and Diabetic Ketoacidosis (Case Report; Two Children with Newly Diagnosed Diabetes). Ann Afr Med. 2023 Jul-Sep;22(3):388-391.
- Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, Bray GA, Schade DS, Temprosa MG, White NH, Crandall JP; Diabetes Prevention Program Research Group. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016 Apr;101(4):1754-61.
Türkiye’nin Güneyindeki İkinci Basamak Bir Sağlık Merkezinde, COVİD-19 Salgını Sırasında ve Sonrasında Tip 1 Diyabet Tanısı Alan Çocukların Tanı Özelliklerinin Değerlendirilmesi
Öz
Amaç: COVİD-19 salgını yüksek morbidite ve mortaliteye sahip küresel bir sağlık sorunu olmuştur. Bu çalışmada pandemi sırasında ve pandemi sonrasında tip 1 diyabet (T1D) tanısı alan hastaların klinik ve laboratuvar bulgularının karşılaştırılması amaçlandı.
Yöntem: 30 aylık, tek merkezli, kesitsel bir çalışma şeklinde dizayne edilen bu çalışmada Ekim 2020 ile Aralık 2021 arası pandemi dönemi, Ocak 2022 ile Mart 2023 arası ise pandemi sonrası dönem olarak tanımlandı. Bu iki dönemde başvuran yeni tanı alan T1DM hastalarının klinik ve laboratuvar parametreleri karşılaştırıldı.
Bulgular: Pandemi döneminde 87 hastaya tanı konulurken, pandemi sonrası dönemde 86 hastaya tanı konuldu. Pandemi döneminde tanı alan erkek hasta oranı anlamlı olarak daha yüksekti (sırasıyla %56, %36, p=0,007). Pandemi döneminde tanı konulanlarda Anti-Adacık Hücre Antikoru (ICA) pozitifliği istatistiksel olarak anlamlı derecede yüksekti. (sırasıyla %52,6, %18,6, p<0,001). Gruplar arasında hemoglobin A1C, tiroid otoantikorları ve doku transglutaminaz antikorları açısından fark yoktu (p>0,05). Pandemi döneminde tanı konulanlarda C peptid düzeyleri anlamlı derecede düşüktü (sırasıyla 0,39±0,4, 0,63±0,6, p) =0,021). Pandemi sırasında şiddetli asidoz nedeniyle başvurular, pandemi sonrasına göre daha sık görüldü (sırasıyla %29,9, %16,3, p=0,151).
Sonuç: İkinci basamak sağlık merkezimizde yeni tnaı koyulan T1D hastası çocukların sayısı pandemi sırasında ve sonrasında benzerdi. Pandemi döneminde otoantikor pozitifliği, C-peptid düşüklüğü ve ciddi asidoz şikayetleriyle başvurular daha sıktı.
Anahtar Kelimeler
Kaynakça
- Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71–6.
- Republic of Turkish Ministry of Health Covid-19 Information page. General Coronavirus Table. Available from: https://covid19.saglik.gov.tr/EN-69532/general-coronavirus-table.html.
- Rabbone I, Schiaffini R, Cherubini V, Maffeis C, Scaramuzza A. Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children? Diabetes Care 2020;43:2870–2.
- Ho J, Rosolowsky E, Pacaud D, Huang C, Lemay JA, Brockman N, et al. Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic. Pediatr Diabetes 2021; 22:552–7.
- Orhan Kılıç B, Kılıç S, Gül Ateş E. Vitamin D Status in Turkish Children During the Covid-19 Pandemic; A Single Center Experience. Genel Tıp Derg. 2023;33(4):390-3.
- Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al.ISPAD Clinical Practice Consensus Guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;27(19 Suppl):155–77.
- https://data.tuik.gov.tr/Kategori/GetKategori?p=nufus-ve-demografi-109&dil=1
- Republic of Turkey Ministry of Health Covid 19 Vaccination information platform. Available from: https://covid19asi.saglik.gov.tr/?_Dil=2
- Jalilova A, Ata A, Demir G, Işıklar H, Atik Altınok Y, Özen S, Darcan Ş, Gökşen D. The Effect of the SARS-CoV-2 Pandemic on Presentation with Diabetic Ketoacidosis in Children with New Onset Type 1 Diabetes Mellitus. J Clin Res Pediatr Endocrinol. 2023 Aug 23;15(3):264-267.
- Rewers M, Ludvigsson J. Environmental risk factors for type 1 diabetes. Lancet 2016;387:2340–8.
- Karavanaki K, Tsoka E, Liacopoulou M, Karayianni C, Petrou V, Pippidou E, et al. Psychological stress as a factor potentially contributing to the pathogenesis of Type 1 diabetes mellitus. J Endocrinol Invest 2008;31:406–15.
- Kamrath C., Rosenbauer J., Eckert A.J., Siedler K., Bartelt H., Klose D., et al. Incidence of type 1 diabetes in children and adolescents during the Covid-19 pandemic in Germany: results From the DPV Registry. Diabetes Care. 2022;45:1762‑71
- Reschke F., Lanzinger S., Herczeg V., Prahalad P., Schiaffini R., Mul D., et al. The Covid-19 pandemic affects seasonality, with increasing cases of new-onset type 1 diabetes in children, from the worldwide SWEET Registry. Diabetes Care. 2022
- McKeigue P.M., McGurnaghan S., Blackbourn L., Bath L.E., McAllister D.A., Caparrotta T.M., et al. Relation of incident type 1 diabetes to recent Covid-19 infection: cohort study using e-health record linkage in Scotland. Diabetes Care. 2022
- Birkebaek N.H., Kamrath C., Grimsmann J.M., Aakesson K., Cherubini V., Dovc K., et al. Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries. Lancet Diabetes Endocrinol. 2022 S2213-8587(22)00246-7.
- Fierabracci A, Arena A, Rossi P. COVID-19: A Review on Diagnosis, Treatment, and Prophylaxis. Int J Mol Sci. 2020;21:5145. doi: 10.3390/ijms21145145
- Schiaffini R, Campana A, Deodati A, Peschiaroli E, Lanzillotta MF, Fierabracci A. SARS-CoV-2 infection as possible downstream disease precipitator in autoantibody-positive insulin-dependent diabetes mellitus: a case report. Ital J Pediatr. 2022 Feb 23;48(1):33
- Pascolini S, Vannini A, Deleonardi G, Ciordinik M, Sensoli A, Carletti I, et al. COVID-19 and immunological dysregulation: can autoantibodies be useful? Clin Transl Sci 2021;14:502–8.
- Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020;395:1771–8.
- Chang, R. et al. Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study. eClinicalMedicine 56, 101783 (2023).
- Falko Tesch, Franz Ehm, Annika Vivirito, Danny Wende et al. Incident autoimmune diseases in association with a SARS-CoV-2 infection: A matched cohort study. medRxiv 2023.01.25.2328501
- Lania A, Sandri MT, Cellini M, Mirani M, Lavezzi E, Mazziotti G.Thyrotoxicosis in patients with COVID-19: the THYRCOV study. Eur J Endocrinol 2020;183:381–7.
- Tee LY, Harjanto S, Rosario BH. COVID-19 complicated by Hashimoto’s thyroiditis. Singapore Med J 2021;62:265.
- Schiaffini R, Campana A, Deodati A, Peschiaroli E, Lanzillotta MF, Fierabracci A. SARS-CoV-2 infection as possible downstream disease precipitator in autoantibody-positive insulin-dependent diabetes mellitus: a case report. Ital J Pediatr. 2022 Feb 23;48(1):33.
- Cabrera-Rode E, Sarmiento L, Tiberti C, Molina G, Barrios J, Hernández D, et al. Type 1 diabetes islet associated antibodies in subjects infected by echovirus 16. Diabetologia 2003;46:1348–53.
- Kulmala P, Savola K, Reijonen H, Veijola R, Vähäsalo P, Karjalainen J, et al. Genetic markers, humoral autoimmunity, and prediction of type 1 diabetes in siblings of affected children. Childhood diabetes in Finland study group. Diabetes 2000;49:48–58.
- Knip M. Prediction and prevention of type 1 diabetes. Acta Paediatr 1998;425:54–62.
- Sepa A, Wahlberg J, Vaarala O, Frodi A, Ludvigsson J. Psychological stress may induce diabetes-related autoimmunity in infancy. Diabetes Care 2005;28:290–5.
- Ardicli D, Kandemir N, Alikasifoglu A, Ozon A, Gonc N. Clinical characteristics of type 1 diabetes over a 40 year period in Turkey: secular trend towards earlier age of onset. J Pediatr Endocrinol Metab. 2014 Jul;27(7-8):635-41.
- Jamiołkowska-Sztabkowska M, Głowińska-Olszewska B, Bossowski A. C-peptide and residual β-cell function in pediatric diabetes - state of the art. Pediatr Endocrinol Diabetes Metab. 2021;27(2):123-133
- Maddaloni E, Cavallari I, Napoli N, Conte C. Vitamin D and Diabetes Mellitus. Front Horm Res. 2018;50:161-176.
- Bouter KP, Diepersloot RJ, Wismans PJ, Gmelig Meyling FH, Hoekstra JB, Heijtink RA, van Hattum J. Humoral immune response to a yeast-derived hepatitis B vaccine in patients with type 1 diabetes mellitus. Diabet Med. 1992 Jan-Feb;9(1):66-9.
- Cömlek FÖ, Sönmez G. Management Difficulties in the Coexistence of Covid-19 Infection and Diabetic Ketoacidosis (Case Report; Two Children with Newly Diagnosed Diabetes). Ann Afr Med. 2023 Jul-Sep;22(3):388-391.
- Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, Bray GA, Schade DS, Temprosa MG, White NH, Crandall JP; Diabetes Prevention Program Research Group. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016 Apr;101(4):1754-61.
Toplam 34 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Endokrinoloji |
| Bölüm | Original Article |
| Yazarlar | |
| Erken Görünüm Tarihi | 27 Nisan 2024 |
| Yayımlanma Tarihi | 30 Nisan 2024 |
| Gönderilme Tarihi | 6 Kasım 2023 |
| Kabul Tarihi | 8 Ocak 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 34 Sayı: 2 |
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