Evidence map›Paper›PMID 36202118›Full record

ArticleThe lancet. Diabetes & endocrinology2022

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.

Niels H Birkebaek, Clemens Kamrath, Julia M Grimsmann, Karin Aakesson, Valentino Cherubini, Klemen Dovc, Carine de Beaufort, Guy T Alonso, John W Gregory, Mary White and 16 more

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. Diabetes & endocrinology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
48citing papers in PubMed, 4 pooled it
14.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

48 citing papers in PubMed, 4 syntheses or guidelines pooled it, 82 citations in OpenAlex.

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  9. Ketoacidosis in new-onset type 1 diabetes: return to pre-COVID-19 pandemic reality?Pediatric endocrinology, diabetes, and metabolism · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

26 authors at 10 institutions in 8 countries.

Niels H BirkebaekDepartment of Pediatrics and Adolescent Medicine and Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark. Electronic address: nielbirk@rm.dk.
Clemens KamrathDivision of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany.
Julia M GrimsmannInstitute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
Karin AakessonDepartment of Paediatrics, County Hospital Ryhov, Jönköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Valentino CherubiniDepartment of Women's and Children's Health, Salesi Hospital, Ancona, Italy.
Klemen DovcDepartment of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC Ljubljana, University Children's Hospital, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Carine de BeaufortDepartment of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg.
Guy T AlonsoBarbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
John W GregoryDivision of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, UK.
Mary WhiteDepartment of Endocrinology and Diabetes, and Health Services Research Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Diabetes Research, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, VIC, Australia.
Torild SkrivarhaugDivision of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Zdenek SumnikDepartment of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czechia; University Hospital Motol, Prague, Czechia.
Craig JefferiesStarship Children's Health and University of Auckland, Auckland, New Zealand.
Thomas HörtenhuberDepartment of Pediatrics and Adolescent Medicine, Kepler University Clinic, Linz, Austria.
Aveni HaynesChildren's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
Martin De BockDepartment of Paediatrics, University of Otago, Christchurch, New Zealand.
Jannet SvenssonSteno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Justin T WarnerDepartment of Paediatric Endocrinology and Diabetes, Children's Hospital for Wales, Cardiff, UK.
Osman GaniDivision of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Rosaria GesuitaCentre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy.
Riccardo SchiaffiniDiabetes Unit, Bambino Gesù Childrens' Hospital, Rome, Italy.
Ragnar HanasNU Hospital Group, Uddevalla, Trollhättan, Sweden; Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
Arleta RewersDenver Scool of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
Alexander J EckertInstitute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
Reinhard W HollInstitute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
Ondrej CinekDepartment of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czechia; University Hospital Motol, Prague, Czechia.
Cardiff University · GBCentre Hospitalier de Luxembourg · LUKepler Universitätsklinikum · ATMarche Polytechnic University · ITNoah's Ark Children's Hospital for Wales · GBOspedali Riuniti di Ancona · ITThe Kids Research Institute Australia · AUUniversity of Colorado Denver · USUniversity of Giessen · DEUniversity of Otago · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAn increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in children was observed in various diabetes centres worldwide during the COVID-19 pandemic. We aimed to evaluate trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes before and during the COVID-19 pandemic, and to identify potential predictors of changes in diabetic ketoacidosis prevalence during the pandemic.

methodsFor this international multicentre study, we used data from 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA [Colorado], and Wales). The study population comprised 104 290 children and adolescents aged 6 months to younger than 18 years, who were diagnosed with type 1 diabetes between Jan 1, 2006, and Dec 31, 2021. The observed diabetic ketoacidosis prevalence in 2020 and 2021 was compared to predictions based on trends over the pre-pandemic years 2006-19. Associations between changes in diabetic ketoacidosis prevalence and the severity of the COVID-19 pandemic and containment measures were examined with excess all-cause mortality in the whole population and the Stringency Index from the Oxford COVID-19 Government Response Tracker.

findings87 228 children and adolescents were diagnosed with type 1 diabetes between 2006 and 2019, 8209 were diagnosed in 2020, and 8853 were diagnosed in 2021. From 2006 to 2019, diabetic ketoacidosis at diagnosis of type 1 diabetes was present in 23 775 (27·3%) of 87 228 individuals and the mean annual increase in the prevalence of diabetic ketoacidosis in the total cohort from 2006 to 2019 was 1·6% (95% CI 1·3 to 1·9). The adjusted observed prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes was 39·4% (95% CI 34·0 to 45·6) in 2020 and 38·9% (33·6 to 45·0) in 2021, significantly higher than the predicted prevalence of 32·5% (27·8 to 37·9) for 2020 and 33·0% (28·3 to 38·5) for 2021 (p<0·0001 for both years). The prevalence of diabetic ketoacidosis was associated with the pandemic containment measures, with an estimated risk ratio of 1·037 (95% CI 1·024 to 1·051; p<0·0001) per ten-unit increase in the Stringency Index for 2020 and 1·028 (1·009 to 1·047; p=0·0033) for 2021, but was not significantly associated with excess all-cause mortality.

interpretationDuring the COVID-19 pandemic, there was a marked exacerbation of the pre-existing increase in diabetic ketoacidosis prevalence at diagnosis of type 1 diabetes in children. This finding highlights the need for early and timely diagnosis of type 1 diabetes in children and adolescents.

fundingGerman Federal Ministry for Education and Research, German Robert Koch Institute, German Diabetes Association, German Diabetes Foundation, Slovenian Research Agency, Welsh Government, Central Denmark Region, and Swedish Association of Local Authorities and Regions.

Indexed as

COVID-19Diabetes Mellitus, Type 1Diabetic KetoacidosisAdolescentChildHumansPandemicsPrevalenceRegistries

Identifiers

PMID36202118
PMCPMC9597608
OpenAlexW4300773102

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.