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.

Thomas Danne, Stefanie Lanzinger, Martin de Bock, Erinn T. Rhodes, G. Todd Alonso, Pascal Barat, Yasmine Elhenawy, Melanie Kershaw, Banshi Saboo, Mauro Scharf Pinto, Agata Chobot, Klemen Dovc,
Diabetes Technology & Therapeutics. 2021-09-01; 23(9): 632-641
DOI: 10.1089/dia.2021.0110

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Danne T(1)(2), Lanzinger S(3)(4), de Bock M(5), Rhodes ET(6), Alonso GT(7), BaratP(8), Elhenawy Y(9), Kershaw M(10), Saboo B(11), Scharf Pinto M(12), Chobot A(13), Dovc K(14).

Author information:
(1)Diabetes Centre, Children’s Hospital AUF DER BULT, Hannover, Germany.
(2)SWEET e.V., Hannoversche Kinderheilanstalt, Hannover, Germany.
(3)Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm,
(4)German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany.
(5)Department of Paediatrics, University of Otago, Christchurch, New Zealand.
(6)Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts,
(7)University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora,
Colorado, USA.
(8)Centre DiaBEA, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
(9)Pediatric and Adolescent Diabetes Unit (PADU), Ain Shams University, Cairo,
(10)Department of Endocrinology and Diabetes, Birmingham Children’s Hospital,
Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK.
(11)DiaCare, Ahmedabad, India.
(12)Centro de Diabetes Curitiba and Division of Pediatric Endocrinology, Hospital
Nossa Senhora das Graças, Curitiba, Brazil.
(13)Department of Pediatrics, Institute of Medical Sciences, University of Opole,
Opole, Poland.
(14)Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases,
UMC-University Children’s Hospital, University Medical Centre Ljubljana,
Ljubljana, Slovenia.

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
centers participating in the Better Control in Pediatric and Adolescent DiabeteS:
Working to CrEate CEnTers of Reference (SWEET) registry. Materials and 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 centers 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 versus 12,157
persons, 52% versus 52% male, median age 13.4 (Q1; Q3: 10.1; 16.2) versus13.5
(10.2; 16.2) years, T1D duration 4.5 (2.1; 7.8) versus 4.5 (2.0; 7.8) years, and
hemoglobin A1c (HbA1c) 60.7 (53.0; 73.8) versus 59.6 (50.8; 70.5) mmol/mol [7.8
(7.0; 8.9) versus 7.6 (6.8; 8.6) %]. Across all country quartiles of COVID-19
mortality, HbA1c and rate of severe hypoglycemia remained comparable to the year
before the first wave, while diabetic ketoacidosis rates increased significantly
in the centers from countries with the highest mortality rate, but returned to
baseline after the wave. Continuous glucose monitoring use decreased slightly
during the first wave (53% vs. 51%) and increased significantly thereafter (55%
vs. 63%, P

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