Aim: The COVID-pandemic has affected access to healthcare services worldwide, including the pediatric population. This systematic review and meta-analysis aimed to estimate the risk of severe diabetic ketoacidosis (DKA) among children with type 1 diabetes (T1DM) during the COVID-pandemic compared pre-pandemic era.

Methods: PubMed, EMBASE, and the Elsevier Coronavirus Research Repository Hub were searched for relevant observational studies. Studies published as an abstract or in non-English language were excluded. The primary outcome is the risk of severe DKA among children with T1DM during the COVID-pandemic compared to the prior-to-COVID-group. The second outcome is the risk of severe DKA among children with newly diagnosed T1DM. A random meta-analysis model was performed using R version 4.0.4 to estimate the relative risk of severe DKA.

Results: A total of 18 studies were included in this metanalysis. Severe DKA risk was 76% (RR 1.76, 95%CI 1.33-2.33, I2=44%) higher during the COVID-pandemic than the pre-COVID-period. Among patients with newly diagnosed T1DM, the risk of severe DKA was 44% higher for the during-COVID-group (RR 1.44, 95%CI 1.26-1.65; I2=64%) . The bias assessment of the included studies using the Newcastle-Ottawa Scale (NOS) showed that all studies had quality indicators (>7 points) . In addition, the results of Eager’s test did not show potential for publication bias.

Conclusions: This study showed that severe DKA risk had increased significantly during the COVID-pandemic compared to the pre-pandemic period.


O.Alfayez: None. J.Alfallaj: None. A.R.Almutairi: None.

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