Trends of new onset type 1 Diabetes Mellitus among children at Mulago and Nsambya Diabetes Clinics: Pre and during the COVID 19 era, a six-year experience.

Abstract

Background: Type 1 Diabetes Mellitus (T1DM) is one of the most common chronic and debilitating diseases in pediatric age, but few studies on its epidemiology exist, especially in low-income countries. Recently, there has been reports of increased incidence of new onset T1DM in children; projected to double by 2045. The COVID-19 pandemic has altered the presentation of T1DM, several studies have documented both increase in T1DM and diabetic keto acidosis (DKA) during the COVID-19 pandemic period. In Uganda, a few studies exist on T1DM and no studies have been done to show if this reported increase is significant for our population. The management of T1DM is expensive and requires planning both as individuals and as a program by the Ministry of Health. The paucity of data on trends of new onset T1DM in Ugandan children makes it difficult to plan management and improve their care in our setting. Objective: This study aimed at describing the trends and characteristics of children and adolescents with new onset T1DM who attended the Mulago and Nsambya Diabetic clinics in the pre and during the COVID 19 pandemic periods. Methodology: This was a retrospective cohort study by review of charts for all children aged 6 months to 19 years with new onset T1DM between March 2017 to February 2023 at two large paediatric T1DM clinics at Mulago and Nsambya Hospitals. Relevant data on social demographic characteristics, date of diagnosis, age at diagnosis, presenting symptoms and duration, anthropometric measurements, history of admission for DKA, family history of diabetes, was collected using a structured questionnaire. Data was collected, checked for completeness, entered and cleaned using kobo collect, then exported to STATA version 17 for analysis. Participants characteristics were compared before and during the COVID-19 Pandemic using Chi-squared and Fisher’s exact tests. Trends of new onset T1DM were analyzed by interrupted time series using 12 time points with 6 months intervals. Results: A total of 245 participants were enrolled into the study. Over half of the participants were female, 138 of 245 (56%), the mean age of diagnosis (SD) was 10.9 (4.5) years. Most participants presented in the COVID 19 period (March 2020-February 2023) as compared to the pre-covid (March 2017-February 2020) years, 148(60.4%) versus 97 (39.6%) respectively, an increase of 52%, but this was not statistically significant (p-value 0.1997). Most children, 162 (66%) presented with DKA, in both time periods pre 60 (61%) and during COVID-19 period 102 (69%) at T1DM diagnosis. Conclusion and recommendations: There is an increasing trend of T1DM in Ugandan children, and most present with DKA. There is need for a high index of suspicion by health workers to facilitate early diagnosis of T1DM. There is need for nationwide sensitization of health workers on diagnosis T1DM and emergency management of DKA to prevent associated complications. Further research is needed to establish the causal relationship between SARS-CoV-2 and T1DM