ESPE Abstracts

Introduction: There is some evidence to suggest that the SARS-CoV-2 virus affects endocrine organs and metabolic processes. However much of the available evidence involves adults. We conducted a systematic review to summarise recent evidence on the effects of COVID-19 on the incidence and disease control of type I diabetes mellitus (T1DM) among children and adolescents.

Method: We conducted a literature search up to 05/03/2023 on PubMed, Scopus, and Google Scholar to identify publications reporting incidence and disease control of type I diabetes mellitus (T1DM) among children and adolescents in association with the COVID-19 pandemic using pre-specified keywords, and additionally perusing additional references from relevant articles.

Results: Following the defined search strategy, 12 studies were found to be eligible for the systematic review. Six studies involving 1396 children/adolescents reported on the incidence of new onset T1DM/ DKA during the pandemic. Incidenc of TID increased. Two studies from Canada and Finland reported an increased incidence of new-onset T1DM from 0.13-6.25 before the pandemic to 0.38-20 during the pandemic, while 5 studies (from Canada, Finland, Kuwait, and the UK), reported and increased incidence of DKA among children with new-onset T1DM during the pandemic compared with the pre-pandemic era. When considering disease control in children with pre-existing T1DM, six studies (three from Italy, one each from Canada, Spain, and Greece) involving 598 children/adolescents, all reported improved glycemic control during the pandemic (with improved blood glucose values including increased Time-In-Range, and reduced Time-Above-Range, Time-Below-Range, Coefficient-of-Variation and HbA1C during lockdown) compared with pre-pandemic values.

Conclusion: There appeared to be an increase in the incidence of T1DM among children/adolescents and the number presenting with DKA, during the COVID pandemic. Evidence on the effects of glycaemic control is somewhat conflicting but more studies reported an improvement of glycaemia control during the lockdown period. We postulate that the coronavirus could be an aetiological factor inducing rapid onset of T1DM, leading to increased incidence and presentation with DKA, while improvement in glycaemic control could be due to increased time available for self-care and parental supervision of diabetes control following reduced work/ school-activities due to lockdown.