A worldwide perspective on COVID-19 and diabetes management in 22,820 children from the SWEET project: diabetic ketoacidosis rates increase and glycemic control is maintained.

Danne, Thomas; Lanzinger, Stefanie; de Bock, Martin Isaac; Rhodes, Erinn T; Alonso, Guy Todd; Barat, Pascal; Elhenawy, Yasmine; Kershaw, Melanie; Saboo, Banshi; Scharf, Mauro; Chobot, Agata; Dovc, Klemen

AIMS To investigate the short-term effects of the first wave of COVID-19 on clinical parameters in children with type 1 diabetes (T1D) from 82 worldwide centres participating in the SWEET registry. METHODS Aggregated data per person with T1D ≤ 21 years of age were compared between May/June 2020 (first wave), August/September 2020 (after wave) and the same periods in 2019. Hierarchic linear and logistic regression models were applied. Models were adjusted for gender, age- and diabetes duration-groups. To distinguish the added burden of the COVID-19 pandemic, the centres were divided into quartiles of first wave COVID-19 associated mortality in their country. RESULTS In May/June 2019 and 2020, respectively, there were 16,735 vs. 12,157 persons, 52 vs. 52 % male, median age 13.4 [Q1;Q3: 10,1; 16.2] vs.13.5 [10,2; 16.2] years, T1D duration 4.5 [2.1; 7.8] vs. 4.5 [2.0; 7.8] years and HbA1c 60.7 [53.0; 73.8] vs. 59.6 [50.8; 70.5] mmol/mol (7.8 [7.0; 8.9] vs. 7.6 [6.8; 8.6] %). Across all country quartiles of COVID-19 mortality, HbA1c and rate of severe hypoglycaemia remained comparable to the year prior to the first wave, while DKA rates increased significantly in the centres from countries with the highest mortality rate but returned to baseline after the wave. CGM use decreased slightly during the first wave (53 vs. 51%) and increased significantly thereafter (55 vs. 63%, p<0.001). CONCLUSIONS Although glycaemic control was maintained, a significant rise in DKA at follow-up was seen during first wave in the quartile of countries with the highest COVID mortality. TRIAL REGISTRATION NCT04427189.