Epidemiological trends in the presentation of diabetic ketoacidosis in children newly diagnosed with type 1 diabetes from 2011 to 2017 in Kuwait.

Background: Monitoring the trends in the presentation of T1D over decades cannot be underestimated as it provides a rich source of information on diabetes-related complications like DKA. DKA represents a medical emergency, with potentially fatal outcome, and thus the prevention of DKA is a priority in diabetes care. The aim of this study is to report on trends in the presentation of DKA in children newly diagnosed with T1D in Kuwait. Material and methods: This study is based on a retrospective review of children newly diagnosed with T1D aged 14 years or less at three Governmental Hospitals representing three health sectors out of the total six health sectors in the country during the period 2011-2017. Results: A total of 799 children (376 males and 423 females) were newly diagnosed with T1D. 287 children presented with DKA (35.9%) with only 73 children (9.1%) classified as severe. During the years 2011 to 2017, we note that the percentage of children older than 6 years of age presenting with severe DKA has decreased significantly (p=0.022). Unfortunately, this has not been replicated in children younger than 6 years. Conclusion: This study highlights the importance of continued monitoring of clinical characteristics of children at diagnosis of T1D specifically presenting with DKA to enable diabetes care professionals to appreciate the multifaceted aspects of T1D, in particular the importance of raising awareness of the early signs of the onset of T1D with special attention to DKA and its severe consequences.

Health-related quality of life of children and adolescents with type 1 diabetes during the COVID-19 pandemic in Kuwait.

Background: With the rapid transmission of COVID-19 globally, countries have implemented strict governmental measures and social distancing rules that aimed to minimize the spread of the virus. School closures, quarantine orders, and social isolation, coupled with a surge in family stress and lack of peer interactions, are probable causes of mental health complications and psychological symptoms faced by children. This study aims at comparing the HRQoL of children and adolescents with type 1 diabetes (T1D) and affected by COVID-19 infection (personal or familial) and those who were not affected by COVID-19. Materials and methods: A random sample was selected from children and adolescents diagnosed with T1D at the six major governmental diabetes centers in Kuwait. To measure HRQoL, parent-proxy and self-reports from the Pediatric Quality of Life Inventory (PedsQLTM) 3.0 Diabetes Module were used. Results: A sample of 455 children and adolescents with T1D diabetes (44.6% male participants and 41.98% affected by COVID-19 infection) was studied. The total score of the HRQoL self-reports was significantly higher compared with parent-proxy reports (79.06 ± 15.19 vs. 73.79 ± 15.17, p < 0.01). Children reported significantly higher HRQoL scores in the "treatment I" domain and "worry" domain and lower scores in the "diabetes" symptoms domain, compared with their parents' reports (p < 0.01). In the COVID-19-affected group, a major difference was noticed between the total scores of children and parent-proxy reports (77.04 ± 15.81 vs. 72.80±14.90, p = 0.047). The affected children reported significantly lower scores in "diabetes" symptoms (59.50) (p < 0.01) and higher scores in the "treatment I" domain (81.43) than their parent-proxy reports (72.05) (p < 0.01). Conclusion: This is the first report on the health-related quality of life of children with T1D in Kuwait during the COVID-19 era. Parents' or caregivers' experience of caring for their children was negative, as they worried, and reported poorer HRQoL compared with their children's perceptions. There is a need to empower healthcare professionals to support parents and caregivers of children with chronic diseases such as T1D in promoting self-management, enhancing physical and psychological wellbeing, treatment adherence, and continuous health education during pandemics of any kind.