The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

Valentino Cherubini; Monica Marino; Andrea E. Scaramuzza; Valentina Tiberi; Adriana Bobbio; Maurizio Delvecchio; Elvira Piccinno; Federica Ortolani; Stefania Innaurato; Barbara Felappi; Francesco Gallo; Carlo Ripoli; Maria Rossella Ricciardi; Filomena Pascarella; Filomena A. Stamati; Felice Citriniti; Claudia Arnaldi; Sara Monti; Vanna Graziani; Fiorella De Berardinis; Cosimo Giannini; Francesco Chiarelli; Maria Zampolli; Rosaria De Marco; Giulia Patrizia Bracciolini; Caterina Grosso; Valeria De Donno; Barbara Piccini; Sonia Toni; Susanna Coccioli; Giuliana Cardinale; Marta Bassi; Nicola Minuto; Giuseppe D’Annunzio; Claudio Maffeis; Marco Marigliano; Angela Zanfardino; Dario Iafusco; Assunta S. Rollato; Alessia Piscopo; Stefano Curto; Fortunato Lombardo; Bruno Bombaci; Silvia Sordelli; Chiara Mameli; Maddalena Macedoni; Andrea Rigamonti; Riccardo Bonfanti; Giulio Frontino; Barbara Predieri; Patrizia Bruzzi; Enza Mozzillo; Francesco Rosanio; Adriana Franzese; Gavina Piredda; Francesca Cardella; Brunella Iovane; Valeria Calcaterra; Maria Giulia Berioli; Anna Lasagni; Valentina Pampanini; Patrizia Ippolita Patera; Riccardo Schiaffini; Irene Rutigliano; Gianfranco Meloni; Luisa De Sanctis; Davide Tinti; Michela Trada; Lucia Paola Guerraggio; Roberto Franceschi; Vittoria Cauvin; Gianluca Tornese; Francesca Franco; Gianluca Musolino; Giulio Maltoni; Valentina Talarico; Antonio Iannilli; Lorenzo Lenzi; Maria Cristina Matteoli; Erica Pozzi; Carlo Moretti; Stefano Zucchini; Ivana Rabbone; Rosaria Gesuita

doi:10.3389/fendo.2022.878634

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

Valentino Cherubini, Monica Marino, Andrea E. Scaramuzza, Valentina Tiberi, Adriana Bobbio, Maurizio Delvecchio, Elvira Piccinno, Federica Ortolani, Stefania Innaurato, Barbara Felappi, Francesco Gallo, Carlo Ripoli, Maria Rossella Ricciardi, Filomena Pascarella, Filomena A. Stamati, Felice Citriniti, Claudia Arnaldi, Sara Monti, Vanna Graziani, Fiorella De BerardinisCosimo Giannini, Francesco Chiarelli, Maria Zampolli, Rosaria De Marco, Giulia Patrizia Bracciolini, Caterina Grosso, Valeria De Donno, Barbara Piccini, Sonia Toni, Susanna Coccioli, Giuliana Cardinale, Marta Bassi, Nicola Minuto, Giuseppe D’Annunzio, Claudio Maffeis, Marco Marigliano, Angela Zanfardino, Dario Iafusco, Assunta S. Rollato, Alessia Piscopo, Stefano Curto, Fortunato Lombardo, Bruno Bombaci, Silvia Sordelli, Chiara Mameli, Maddalena Macedoni, Andrea Rigamonti, Riccardo Bonfanti, Giulio Frontino, Barbara Predieri, Patrizia Bruzzi, Enza Mozzillo, Francesco Rosanio, Adriana Franzese, Gavina Piredda, Francesca Cardella, Brunella Iovane, Valeria Calcaterra, Maria Giulia Berioli, Anna Lasagni, Valentina Pampanini, Patrizia Ippolita Patera, Riccardo Schiaffini, Irene Rutigliano, Gianfranco Meloni, Luisa De Sanctis, Davide Tinti, Michela Trada, Lucia Paola Guerraggio, Roberto Franceschi, Vittoria Cauvin, Gianluca Tornese, Francesca Franco, Gianluca Musolino, Giulio Maltoni, Valentina Talarico, Antonio Iannilli, Lorenzo Lenzi, Maria Cristina Matteoli, Erica Pozzi, Carlo Moretti, Stefano Zucchini, Ivana Rabbone, Rosaria Gesuita

Dipartimento di Scienze della Salute

Risultato della ricerca: Contributo su rivista › Articolo in rivista › peer review

Abstract

Aim/Hypothesis: To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019. Methods: Forty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019. Results: Overall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p<0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p<0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively). Conclusions/Interpretation: There was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.

Lingua originale	Inglese
Numero di articolo	878634
Rivista	Frontiers in Endocrinology
Volume	13
DOI	https://doi.org/10.3389/fendo.2022.878634
Stato di pubblicazione	Pubblicato - 17 giu 2022

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10.3389/fendo.2022.878634

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Cherubini, V., Marino, M., Scaramuzza, A. E., Tiberi, V., Bobbio, A., Delvecchio, M., Piccinno, E., Ortolani, F., Innaurato, S., Felappi, B., Gallo, F., Ripoli, C., Ricciardi, M. R., Pascarella, F., Stamati, F. A., Citriniti, F., Arnaldi, C., Monti, S., Graziani, V., ... Gesuita, R. (2022). The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020. Frontiers in Endocrinology, 13, Articolo 878634. https://doi.org/10.3389/fendo.2022.878634

@article{56f988a384014843824c099b35acb48a,

title = "The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020",

abstract = "Aim/Hypothesis: To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019. Methods: Forty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019. Results: Overall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p<0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p<0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively). Conclusions/Interpretation: There was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.",

keywords = "COVID - 19, DKA, diabetes onset, socioeconomic status, type 1 diabetes",

author = "Valentino Cherubini and Monica Marino and Scaramuzza, {Andrea E.} and Valentina Tiberi and Adriana Bobbio and Maurizio Delvecchio and Elvira Piccinno and Federica Ortolani and Stefania Innaurato and Barbara Felappi and Francesco Gallo and Carlo Ripoli and Ricciardi, {Maria Rossella} and Filomena Pascarella and Stamati, {Filomena A.} and Felice Citriniti and Claudia Arnaldi and Sara Monti and Vanna Graziani and {De Berardinis}, Fiorella and Cosimo Giannini and Francesco Chiarelli and Maria Zampolli and {De Marco}, Rosaria and Bracciolini, {Giulia Patrizia} and Caterina Grosso and {De Donno}, Valeria and Barbara Piccini and Sonia Toni and Susanna Coccioli and Giuliana Cardinale and Marta Bassi and Nicola Minuto and Giuseppe D{\textquoteright}Annunzio and Claudio Maffeis and Marco Marigliano and Angela Zanfardino and Dario Iafusco and Rollato, {Assunta S.} and Alessia Piscopo and Stefano Curto and Fortunato Lombardo and Bruno Bombaci and Silvia Sordelli and Chiara Mameli and Maddalena Macedoni and Andrea Rigamonti and Riccardo Bonfanti and Giulio Frontino and Barbara Predieri and Patrizia Bruzzi and Enza Mozzillo and Francesco Rosanio and Adriana Franzese and Gavina Piredda and Francesca Cardella and Brunella Iovane and Valeria Calcaterra and Berioli, {Maria Giulia} and Anna Lasagni and Valentina Pampanini and Patera, {Patrizia Ippolita} and Riccardo Schiaffini and Irene Rutigliano and Gianfranco Meloni and {De Sanctis}, Luisa and Davide Tinti and Michela Trada and Guerraggio, {Lucia Paola} and Roberto Franceschi and Vittoria Cauvin and Gianluca Tornese and Francesca Franco and Gianluca Musolino and Giulio Maltoni and Valentina Talarico and Antonio Iannilli and Lorenzo Lenzi and Matteoli, {Maria Cristina} and Erica Pozzi and Carlo Moretti and Stefano Zucchini and Ivana Rabbone and Rosaria Gesuita",

note = "Publisher Copyright: Copyright {\textcopyright} 2022 Cherubini, Marino, Scaramuzza, Tiberi, Bobbio, Delvecchio, Piccinno, Ortolani, Innaurato, Felappi, Gallo, Ripoli, Ricciardi, Pascarella, Stamati, Citriniti, Arnaldi, Monti, Graziani, De Berardinis, Giannini, Chiarelli, Zampolli, De Marco, Bracciolini, Grosso, De Donno, Piccini, Toni, Coccioli, Cardinale, Bassi, Minuto, D{\textquoteright}Annunzio, Maffeis, Marigliano, Zanfardino, Iafusco, Rollato, Piscopo, Curto, Lombardo, Bombaci, Sordelli, Mameli, Macedoni, Rigamonti, Bonfanti, Frontino, Predieri, Bruzzi, Mozzillo, Rosanio, Franzese, Piredda, Cardella, Iovane, Calcaterra, Berioli, Lasagni, Pampanini, Patera, Schiaffini, Rutigliano, Meloni, De Sanctis, Tinti, Trada, Guerraggio, Franceschi, Cauvin, Tornese, Franco, Musolino, Maltoni, Talarico, Iannilli, Lenzi, Matteoli, Pozzi, Moretti, Zucchini, Rabbone and Gesuita.",

year = "2022",

month = jun,

day = "17",

doi = "10.3389/fendo.2022.878634",

language = "English",

volume = "13",

journal = "Frontiers in Endocrinology",

issn = "1664-2392",

publisher = "Frontiers Media S.A.",

}

Cherubini, V, Marino, M, Scaramuzza, AE, Tiberi, V, Bobbio, A, Delvecchio, M, Piccinno, E, Ortolani, F, Innaurato, S, Felappi, B, Gallo, F, Ripoli, C, Ricciardi, MR, Pascarella, F, Stamati, FA, Citriniti, F, Arnaldi, C, Monti, S, Graziani, V, De Berardinis, F, Giannini, C, Chiarelli, F, Zampolli, M, De Marco, R, Bracciolini, GP, Grosso, C, De Donno, V, Piccini, B, Toni, S, Coccioli, S, Cardinale, G, Bassi, M, Minuto, N, D’Annunzio, G, Maffeis, C, Marigliano, M, Zanfardino, A, Iafusco, D, Rollato, AS, Piscopo, A, Curto, S, Lombardo, F, Bombaci, B, Sordelli, S, Mameli, C, Macedoni, M, Rigamonti, A, Bonfanti, R, Frontino, G, Predieri, B, Bruzzi, P, Mozzillo, E, Rosanio, F, Franzese, A, Piredda, G, Cardella, F, Iovane, B, Calcaterra, V, Berioli, MG, Lasagni, A, Pampanini, V, Patera, PI, Schiaffini, R, Rutigliano, I, Meloni, G, De Sanctis, L, Tinti, D, Trada, M, Guerraggio, LP, Franceschi, R, Cauvin, V, Tornese, G, Franco, F, Musolino, G, Maltoni, G, Talarico, V, Iannilli, A, Lenzi, L, Matteoli, MC, Pozzi, E, Moretti, C, Zucchini, S, Rabbone, I & Gesuita, R 2022, 'The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020', Frontiers in Endocrinology, vol. 13, 878634. https://doi.org/10.3389/fendo.2022.878634

TY - JOUR

T1 - The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

AU - Cherubini, Valentino

AU - Marino, Monica

AU - Scaramuzza, Andrea E.

AU - Tiberi, Valentina

AU - Bobbio, Adriana

AU - Delvecchio, Maurizio

AU - Piccinno, Elvira

AU - Ortolani, Federica

AU - Innaurato, Stefania

AU - Felappi, Barbara

AU - Gallo, Francesco

AU - Ripoli, Carlo

AU - Ricciardi, Maria Rossella

AU - Pascarella, Filomena

AU - Stamati, Filomena A.

AU - Citriniti, Felice

AU - Arnaldi, Claudia

AU - Monti, Sara

AU - Graziani, Vanna

AU - De Berardinis, Fiorella

AU - Giannini, Cosimo

AU - Chiarelli, Francesco

AU - Zampolli, Maria

AU - De Marco, Rosaria

AU - Bracciolini, Giulia Patrizia

AU - Grosso, Caterina

AU - De Donno, Valeria

AU - Piccini, Barbara

AU - Toni, Sonia

AU - Coccioli, Susanna

AU - Cardinale, Giuliana

AU - Bassi, Marta

AU - Minuto, Nicola

AU - D’Annunzio, Giuseppe

AU - Maffeis, Claudio

AU - Marigliano, Marco

AU - Zanfardino, Angela

AU - Iafusco, Dario

AU - Rollato, Assunta S.

AU - Piscopo, Alessia

AU - Curto, Stefano

AU - Lombardo, Fortunato

AU - Bombaci, Bruno

AU - Sordelli, Silvia

AU - Mameli, Chiara

AU - Macedoni, Maddalena

AU - Rigamonti, Andrea

AU - Bonfanti, Riccardo

AU - Frontino, Giulio

AU - Predieri, Barbara

AU - Bruzzi, Patrizia

AU - Mozzillo, Enza

AU - Rosanio, Francesco

AU - Franzese, Adriana

AU - Piredda, Gavina

AU - Cardella, Francesca

AU - Iovane, Brunella

AU - Calcaterra, Valeria

AU - Berioli, Maria Giulia

AU - Lasagni, Anna

AU - Pampanini, Valentina

AU - Patera, Patrizia Ippolita

AU - Schiaffini, Riccardo

AU - Rutigliano, Irene

AU - Meloni, Gianfranco

AU - De Sanctis, Luisa

AU - Tinti, Davide

AU - Trada, Michela

AU - Guerraggio, Lucia Paola

AU - Franceschi, Roberto

AU - Cauvin, Vittoria

AU - Tornese, Gianluca

AU - Franco, Francesca

AU - Musolino, Gianluca

AU - Maltoni, Giulio

AU - Talarico, Valentina

AU - Iannilli, Antonio

AU - Lenzi, Lorenzo

AU - Matteoli, Maria Cristina

AU - Pozzi, Erica

AU - Moretti, Carlo

AU - Zucchini, Stefano

AU - Rabbone, Ivana

AU - Gesuita, Rosaria

N1 - Publisher Copyright: Copyright © 2022 Cherubini, Marino, Scaramuzza, Tiberi, Bobbio, Delvecchio, Piccinno, Ortolani, Innaurato, Felappi, Gallo, Ripoli, Ricciardi, Pascarella, Stamati, Citriniti, Arnaldi, Monti, Graziani, De Berardinis, Giannini, Chiarelli, Zampolli, De Marco, Bracciolini, Grosso, De Donno, Piccini, Toni, Coccioli, Cardinale, Bassi, Minuto, D’Annunzio, Maffeis, Marigliano, Zanfardino, Iafusco, Rollato, Piscopo, Curto, Lombardo, Bombaci, Sordelli, Mameli, Macedoni, Rigamonti, Bonfanti, Frontino, Predieri, Bruzzi, Mozzillo, Rosanio, Franzese, Piredda, Cardella, Iovane, Calcaterra, Berioli, Lasagni, Pampanini, Patera, Schiaffini, Rutigliano, Meloni, De Sanctis, Tinti, Trada, Guerraggio, Franceschi, Cauvin, Tornese, Franco, Musolino, Maltoni, Talarico, Iannilli, Lenzi, Matteoli, Pozzi, Moretti, Zucchini, Rabbone and Gesuita.

PY - 2022/6/17

Y1 - 2022/6/17

N2 - Aim/Hypothesis: To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019. Methods: Forty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019. Results: Overall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p<0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p<0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively). Conclusions/Interpretation: There was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.

AB - Aim/Hypothesis: To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019. Methods: Forty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019. Results: Overall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p<0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p<0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively). Conclusions/Interpretation: There was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.

KW - COVID - 19

KW - DKA

KW - diabetes onset

KW - socioeconomic status

KW - type 1 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85133549309&partnerID=8YFLogxK

U2 - 10.3389/fendo.2022.878634

DO - 10.3389/fendo.2022.878634

M3 - Article

SN - 1664-2392

VL - 13

JO - Frontiers in Endocrinology

JF - Frontiers in Endocrinology

M1 - 878634

ER -

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

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