Title Severity of pediatrics ketoacidosis before and during COVID-19 pandemic Title (croatian) Ozbiljnost pedijatrijske ketoacidoze prije i tijekom pandemije COVID-19 Author Fritz Müller Mentor Peter Georg Dahlem (mentor) Committee member Johannes Brachmann (predsjednik povjerenstva) Committee member Walter Ludwig Strohmaier (član povjerenstva) Committee member Ivana Pavlinac Dodig (član povjerenstva)Granter University of Split Defense date and country 2022-09-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Objectives: With this study we tried to find an impact of the COVID-19 pandemic on the pediatric patients presenting at the pediatric emergency department with a diabetic ketoacidosis. For this we compared the patients presenting at the ED from the 11th of March 2020 until the 11th of March 2022, after the WHO declared a pandemic situation with those who presented between January 1st 2012 and December 31st 2019.
Materials and Methods: This retrospective observational study was conducted with the available data from the pediatric ward in the REGIOMED hospital Coburg. The categorization for severity of diabetic ketoacidosis was done according to the current S3 guideline for the therapy of Diabetes Mellitus, valid in Germany at the time of the study. We compared the severity from 49 cases in group A and 12 cases in group B, after all necessary exclusions were performed. Apart from the severity we compared laboratory values for pH, bicarbonates, blood glucose and glycated hemoglobin A1c (HbA1c). The comparisons were performed for the whole groups, and between groups A and B divided for gender.
Results: There was no statistically significant difference in severity of diabetic ketoacidosis between group A and group B (P=0.435). When comparing the severity between groups A and B according to gender, no difference could be found in the female subgroup (P=0.957), but a statistically significant change in the male subgroup (P=0.031) could be seen. There was no difference in the pH values (P=0.227), also not when divided according to gender (male P=0.146 and female P=0.521). This was again seen in the analysis of bicarbonate concentrations, no difference could be found (P=0.218), the male subgroup had a P-value of 0.082 and the female subgroup a P-value of 0.617. The blood glucose at admission in both groups was in the expected range with a mean value of 512.6 mg/dl in group A and 544.3 mg/dl in group B. With P=0.276 no difference could be found, this was also true after division into female (P=0.543) and male (P=0.150). Median HbA1c values were actually higher in group A (11.3%) than in group B (10.65%). We therefore failed to prove worse results (P=0.767). Looking only at the male patients we also had a mean reduction of HbA1c from 11.1% to 10.6% and had no worse outcome in group B (P=0.789). The female patients also had better HbA1c results, their median improving from 11.3% to 10.4%, therefore no worsened long term glycemic control was obvious (P=0.671).
Conclusion: We could not prove a worse patient presentation with diabetic ketoacidosis during the COVID-19 pandemic in general. The only significant worse outcome was the severity in male patients.
Abstract (croatian) Ciljevi: Ovom smo studijom pokušali utvrditi utjecaj pandemije COVID-19 na pedijatrijske pacijente koji se javljaju na hitnu pedijatriju s dijabetičkom ketoacidozom. U tu svrhu usporedili smo pacijente koji su im se javili u razdoblju od 11. ožujka 2020 do 11. ožujka 2022, odnosno nakon što je WHO proglasio pandemijsku situaciju, s onima koji su se javili između 1. siječnja 2012 i 31. prosinca 2019. Materijali i metode: Ova retrospektivna opservacijska studija provedena je uz pomoć dostupnih podataka s pedijatrijskog odjela u bolnici REGIOMED Coburg. Kategorizacija prema ozbiljnosti dijabetičke ketoacidoze učinjena je prema trenutnim S3 smjernicama za terapiju dijabetes melitusa, a koje su bile na snazi u Njemačkoj i u vrijeme istraživanja. Usporedili smo tako težinu iz 49 slučajeva u skupini A i 12 slučajeva u skupini B, nakon što su izvršena sva potrebna isključenja. Osim težine, usporedili smo i laboratorijske vrijednosti za pH, bikarbonate, glukozu u krvi i glikirani hemoglobin A1c (HbA1c). Usporedbe su obavljene za cijele skupine te između skupina A i B podijeljenih prema spolu. Rezultati: Nije bilo statistički značajne razlike u težini dijabetičke ketoacidoze između skupine A i skupine B (P=0.435). Uspoređujući težinu između skupina A i B prema spolu, ustanovili smo da nije bilo razlike u ženskoj podskupini (P=0.957), ali se mogla vidjeti statistički značajna promjena u muškoj podskupini (P=0.031). Isto tako, nije bilo razlike ni u pH vrijednostima (P=0.227), čak ni onda kada bismo gledali s obzirom na spol (muški P=0.146 i ženski P=0.521). Nadalje, analizom koncentracija bikarbonata, opet smo utvrdili to da se nije mogla pronaći veća razlika (P=0.218), muška podskupina imala je P-vrijednost 0.082, a ženska podskupina P-vrijednost 0.617. Glukoza u krvi pri prijemu u obje skupine bila je u očekivanom rasponu sa srednjom vrijednošću od 512.6 mg/dl u skupini A i 544.3 mg/dl u skupini B. S P=0.276 nije se također mogla pronaći razlika, a isto to je vrijedilo i nakon podjele na žene (P=0.543) i muškarci (P=0.150). Srednje vrijednosti HbA1c bile su zapravo više u skupini A (11.3%) nego u skupini B (10.65%). Stoga nismo uspjeli dokazati lošije rezultate (P=0.767). Uzmemo li u obzir samo muške pacijente, isto smo imali prosječno smanjenje HbA1c s 11.1% na 10.6% te lošiji ishod nije bio zabilježen ni u skupini B (P=0.789). Pacijentice su također imale bolje rezultate HbA1c. Njihov medijan poboljšao se s 11.3% na 10.4%, stoga u vezi dugotrajne glikemijske kontrole nisu bila zabilježena značajnija pogoršanja (P=0.671). Zaključak: Općenito govoreći, nismo mogli dokazati lošiju prezentaciju pacijenata s dijabetičkom ketoacidozom tijekom pandemije COVID-19. Jedini značajno lošiji ishod bila je težina kod muških pacijenata.
Keywords
Diabetes Mellitus
diabetic ketoacidosis
COVID-19
pandemic
pediatric
Keywords (croatian)
šećerna bolest
dijabetička ketoacidoza
COVID-19
pandemija
pedijatrija
Language english URN:NBN urn:nbn:hr:171:982474 Study programme Title: Medical Studies in English Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-09-16 13:00:31
