{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:32:15Z","timestamp":1791232335849,"version":"4.1.0"},"update-to":[{"DOI":"10.12688\/f1000research.128687.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000}}],"reference-count":81,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Some studies suggest that the SARS-CoV-2 pandemic increased the incidence of type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA). However, the impact of this pandemic on pediatric T1DM is still mostly unknown. Therefore, we aimed to assess the effect of the COVID-19 pandemic on clinical outcomes in children with T1DM.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    We systematically searched for six databases up to 31 August 2022. We included 46 observational studies, 159,505 children of both sexes with T1DM, and 17,547 DKA events.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    The COVID-19 pandemic significantly increased, in both sexes, the incidence of 1) DKA (OR 1.68; 95% CI 1.44\u20131.96), 2) severe DKA (OR 1.84; 95% CI 1.59\u20132.12), 3) DKA in newly diagnosed T1DM (OR 1.75; 95% CI 1.51\u20132.03), and 4) ICU admissions (OR 1.90; 95% CI 1.60\u20132.26). However, we did not find a significant association between this pandemic and 1) the incidence of T1DM, 2) the incidence of DKA in established T1DM, 3) the incidence of KDA complications, 4) the length of hospitalization stay, and 5) mortality. Subgroup analysis showed that the study design and the continent of origin accounted for the heterogeneity.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions:<\/ns4:bold>\n                    The pandemic SARS-CoV-2 raised, in both sexes, the risk of DKA, severe DKA, DKA\n                    <ns4:italic>de novo<\/ns4:italic>\n                    , and ICU admissions.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.128687.2","type":"journal-article","created":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T11:25:50Z","timestamp":1691666750000},"page":"72","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of the COVID-19 pandemic on the incidence and clinical outcomes of diabetic ketoacidosis among male and female children with type 1 diabetes: systematic review and meta-analysis"],"prefix":"10.12688","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1814-5593","authenticated-orcid":false,"given":"Edinson Dante","family":"Meregildo-Rodriguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9418-3236","authenticated-orcid":false,"given":"Franco Ernesto","family":"Le\u00f3n-Jim\u00e9nez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda Aurora Dolores","family":"Tafur-Hoyos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo Adolfo","family":"V\u00e1squez-Tirado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2023,8,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"56-64","DOI":"10.1111\/pedi.12370","article-title":"Viruses in type 1 diabetes.","volume":"17","author":"H Hy\u00f6ty","year":"2016","journal-title":"Pediatr. Diabetes."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"762","DOI":"10.3390\/v11080762","article-title":"Viruses and Autoimmunity: A Review on the Potential Interaction and Molecular Mechanisms.","volume":"11","author":"M Smatti","year":"2019","journal-title":"Viruses."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"125-136.e7","DOI":"10.1016\/j.stem.2020.06.015","article-title":"A Human Pluripotent Stem Cell-based Platform to Study SARS-CoV-2 Tropism and Model Virus Infection in Human Cells and Organoids.","volume":"27","author":"L Yang","year":"2020","journal-title":"Cell Stem Cell."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3534","DOI":"10.1038\/s41467-021-23886-3","article-title":"Viral infiltration of pancreatic islets in patients with COVID-19.","volume":"12","author":"C Steenblock","year":"2021","journal-title":"Nat. Commun."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"151-157","DOI":"10.1016\/j.arteri.2020.10.001","article-title":"COVID-19 and diabetes: A bidirectional relationship.","volume":"33","author":"M Lima-Mart\u00ednez","year":"2021","journal-title":"Clin Investig Arterioscler."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"789-790","DOI":"10.1056\/NEJMc2018688","article-title":"New-Onset Diabetes in COVID-19.","volume":"383","author":"F Rubino","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e170-e171","DOI":"10.2337\/dc20-1551","article-title":"New-Onset Type 1 Diabetes in Children During COVID-19: Multicenter Regional Findings in the UK.","volume":"43","author":"R Unsworth","year":"2020","journal-title":"Diabetes Care."},{"key":"ref8","first-page":"e16427","article-title":"Evaluation of Characteristics and Out-comes for Patients with Diabetic Ketoacidosis (DKA) With and Without COVID-19 in Elmhurst Queens Dur-ing Similar Three-Month Periods in 2019 and 2020.","volume":"13","author":"U Patel","year":"2021","journal-title":"Cureus."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e83-e85","DOI":"10.2337\/dc20-1088","article-title":"Type 1 Diabetes and COVID-19: Preliminary Findings From a Multicenter Surveillance Study in the U.S.","volume":"43","author":"O Ebekozien","year":"2020","journal-title":"Diabetes Care."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"856958","DOI":"10.3389\/fendo.2022.856958","article-title":"Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies.","volume":"13","author":"O Alfayez","year":"2022","journal-title":"Front Endocrinol (Lausanne)."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1-12","DOI":"10.1038\/s41390-022-02241-2","article-title":"Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes.","author":"A Elgenidy","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"5112-5127","DOI":"10.1002\/jmv.27996","article-title":"The global impact of COVID-19 pan-demic on the incidence of pediatric new-onset type 1 diabetes and ketoacidosis: A systematic review and me-ta-analysis.","volume":"94","author":"M Rahmati","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"535-545","DOI":"10.1016\/j.dsx.2020.04.044","article-title":"Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis.","volume":"14","author":"A Kumar","year":"2020","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"813-822","DOI":"10.1016\/S2213-8587(20)30272-2","article-title":"Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study.","volume":"8","author":"E Barron","year":"2020","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"371-377","DOI":"10.1530\/EC-20-0567","article-title":"Effect of COVID-19 on the clinical course of diabetic ketoacidosis (Dka) in people with type 1 and type 2 diabetes.","volume":"10","author":"P Kempegowda","year":"2021","journal-title":"Endocr. Connect."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"270-272","DOI":"10.1111\/1753-0407.13141","article-title":"Increased DKA at presentation among newly diagnosed type 1 diabetes patients with or without COVID-19: Data from a mul-ti-site surveillance registry.","volume":"13","author":"K Beliard","year":"2021","journal-title":"J. Diabetes."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"801-804","DOI":"10.1001\/jama.2020.13445","article-title":"Ketoacidosis in Children and Adolescents with Newly Diagnosed Type 1 Diabetes during the COVID-19 Pandemic in Germany.","volume":"324","author":"C Kamrath","year":"2020","journal-title":"JAMA."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1411-1421","DOI":"10.18502\/ijph.v49i8.3863","article-title":"Corticosteroids on the Management of Coronavirus Disease 2019 (COVID-19): A Systemic Review and Meta-Analysis.","volume":"49","author":"M Yousefifard","year":"2020","journal-title":"Iran. J. Public Health."},{"key":"ref19","doi-asserted-by":"crossref","first-page":"m2980","DOI":"10.1136\/bmj.m2980","article-title":"Drug treatments for COVID-19: living systematic review and network meta-analysis.","volume":"370","author":"R Siemieniuk","year":"2020","journal-title":"BMJ."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"786-794","DOI":"10.1016\/S2213-8587(22)00246-7","article-title":"Impact of the COVID-19 pan-demic 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.","volume":"10","author":"N Birkebaek","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref21","article-title":"Cochrane Handbook for Systematic Reviews of Interventions.","author":"J Higgins"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.","volume":"6","author":"D Moher","year":"2009","journal-title":"PLoS Med."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: a critical appraisal tool for sys-tematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.","volume":"358","author":"B Shea","year":"2017","journal-title":"BMJ."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s41073-016-0007-6","article-title":"Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use.","volume":"1","author":"S Heidari","year":"diciembre de 2016","journal-title":"Res. Integr. Peer Rev."},{"key":"ref25","doi-asserted-by":"crossref","first-page":"e13249","DOI":"10.1111\/eci.13249","article-title":"Relative risks and odds ratios: Simple rules on when and how to use them.","volume":"50","author":"D McKenzie","year":"2020","journal-title":"Eur. J. Clin. Investig."},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.1177\/09622802231172043","article-title":"Detecting the skewness of data from the five-number summary and its application in meta-analysis.","author":"J Shi","year":"2023","journal-title":"Stat. Methods Med. Res."},{"key":"ref80","doi-asserted-by":"publisher","first-page":"1785-1805","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range.","volume":"27","author":"D Luo","year":"2018","journal-title":"Stat. Methods Med. Res."},{"key":"ref81","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range.","volume":"14","author":"X Wan","year":"2014","journal-title":"BMC Med. Res. Methodol."},{"key":"ref82","doi-asserted-by":"publisher","first-page":"641-654","DOI":"10.1002\/jrsm.1429","article-title":"Optimally estimating the sample standard deviation from the five-number summary.","volume":"11","author":"J Shi","year":"2020","journal-title":"Res. Synth. Methods."},{"key":"ref27","doi-asserted-by":"crossref","first-page":"e3506","DOI":"10.1002\/dmrr.3506","article-title":"Higher rates of dia-betic ketoacidosis and admission to the paediatric intensive care unit among newly diagnosed children with type 1 diabetes in Kuwait during the COVID-19 pandemic.","volume":"38","author":"D Al-Abdulrazzaq","year":"2022","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"669302","DOI":"10.3389\/fendo.2021.669302","article-title":"The Impact of COVID-19 Pandemic Lockdown on the Incidence of New-Onset Type 1 Diabetes and Ketoacidosis Among Saudi Children.","volume":"12","author":"A Alaqeel","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"859-866","DOI":"10.1515\/jpem-2022-0136","article-title":"Effect of COVID-19 pandemic on presentation and referral patterns of newly diagnosed children with type 1 diabetes in a developing country.","volume":"35","author":"A Alassaf","year":"2022","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1654-1655","DOI":"10.1111\/jpc.15081","article-title":"Presentation of pediatric type 1 diabetes in Melbourne, Australia during the initial stages of the COVID-19 pandemic.","volume":"56","author":"G Atlas","year":"2020","journal-title":"J. Paediatr. Child Health."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"551","DOI":"10.3390\/jpm11060551","article-title":"The impact of sars-cov-2 pandemic on the new cases of t1dm in children. A single-centre cohort study.","volume":"11","author":"A Boboc","year":"2021","journal-title":"J Pers Med."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e00235","DOI":"10.1002\/edm2.235","article-title":"The Impact of COVID-19 Pandemic on Prevalence of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: A Single-Centre Study in Central Pennsylvania.","volume":"4","author":"K Bogale","year":"2021","journal-title":"Endocrinol Diabetes Metab."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"479-485","DOI":"10.1016\/j.eprac.2022.02.005","article-title":"Increase in the Number of Pediatric New-Onset Diabetes and Diabetic Ketoacidosis Cases During the COVID-19 Pandemic.","volume":"28","author":"M Chambers","year":"2022","journal-title":"Endocr. Pract."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"878634","DOI":"10.3389\/fendo.2022.878634","article-title":"The Silent Epidemic of Dia-betic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 pandemic in 2020.","volume":"13","author":"V Cherubini","year":"2022","journal-title":"Front Endocrinol (Lausanne)."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"632-641","DOI":"10.1089\/dia.2021.0110","article-title":"A Worldwide Perspective on COVID-19 and Diabetes Management in 22,820 Children from the SWEET Project: Diabetic Ketoacidosis Rates In-crease and Glycemic Control Is Maintained.","volume":"23","author":"T Danne","year":"2021","journal-title":"Diabetes Technol. Ther."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1303-1309","DOI":"10.1515\/jpem-2021-0287","article-title":"Changes in the presentation of newly diagnosed type 1 diabetes in children during the COVID-19 pandemic in a tertiary center in Southern Turkey.","volume":"34","author":"S Dilek","year":"2021","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"222-227","DOI":"10.5152\/TurkArchPediatr.2022.21284","article-title":"The Examination of the Relationship Between COVID-19 and New-Onset Type 1 Diabetes Mellitus in Children.","volume":"57","author":"Z Donbalo\u011flu","year":"2022","journal-title":"Turk Arch. Pediatr."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"167-175","DOI":"10.5114\/pedm.2020.101003","article-title":"Increased frequency of severe diabetic ketoacidosis at type 1 diabetes onset among children during COVID-19 pandemic lockdown: an observational cohort study.","volume":"26","author":"K D\u017cyga\u0142o","year":"2020","journal-title":"Pediatr. Endocrinol. Diabetes Metab."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"17-22","DOI":"10.1002\/pdi.2394","article-title":"Has variable access to health care during the COVID-19 pandemic impacted the severity of paediatric diabetic ketoacidosis?","volume":"39","author":"A Fathi","year":"2022","journal-title":"Pract Diabetes."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"10-18","DOI":"10.1111\/pedi.13296","article-title":"Alarming increase in ke-toacidosis in children and adolescents with newly diagnosed type 1 diabetes during the first wave of the COVID-19 pandemic in Israel.","volume":"23","author":"S Goldman","year":"2022","journal-title":"Pediatr. Diabetes."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"414-415","DOI":"10.1001\/jamapediatrics.2021.5801","article-title":"Incidence of New-Onset Type 1 Diabetes Among US Children During the COVID-19 Global Pandemic.","volume":"176","author":"B Gottesman","year":"2022","journal-title":"JAMA Pediatr."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"783-790","DOI":"10.2147\/DMSO.S294458","article-title":"Increased incidence of pediatric diabetic ketoacidosis after COVID-19: A two-center retrospective study in Korea.","volume":"14","author":"M Han","year":"2021","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref43","doi-asserted-by":"crossref","first-page":"e14461","DOI":"10.1111\/dme.14461","article-title":"A trend towards an early increase in ketoacidosis at presentation of paediatric type 1 diabetes during the coronavirus-2019 pandemic.","volume":"38","author":"C Hawkes","year":"2021","journal-title":"Diabet. Med."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"709-714","DOI":"10.1016\/j.endinu.2021.12.003","article-title":"New diagnoses of type 1 diabetes mellitus in children during the COVID-19 pandemic. Regional multicenter study in Spain.","volume":"69","author":"M Hern\u00e1ndez Herrero","year":"2022","journal-title":"Endocrinol Diabetes Nutr."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"552-557","DOI":"10.1111\/pedi.13205","article-title":"Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic.","volume":"22","author":"J Ho","year":"2021","journal-title":"Pediatr. Diabetes."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1569-1574","DOI":"10.1007\/s13300-021-01049-3","article-title":"Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study.","volume":"12","author":"R Jacob","year":"2021","journal-title":"Diabetes Ther."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e2021050856","DOI":"10.1542\/peds.2021-050856","article-title":"Incidence of COVID-19 and Risk of Diabetic Ketoacidosis in New-Onset Type 1 Diabetes.","volume":"148","author":"C Kamrath","year":"2021","journal-title":"Pediatrics."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"267-274","DOI":"10.4274\/jcrpe.galenos.2022.2021-10-2","article-title":"A Long-Term Comparison of Presenting Characteristics of Children with Newly Diagnosed Type 1 Diabetes Before and During the COVID-19 Pandemic.","volume":"14","author":"G Kaya","year":"2022","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"926013","DOI":"10.3389\/fped.2022.926013","article-title":"Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting With Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey.","volume":"10","author":"E Kiral","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"5928-5935","DOI":"10.26355\/eurrev_202110_26869","article-title":"Impact of COVID-19 on new-onset type 1 diabetes mellitus - A one-year prospective study.","volume":"25","author":"E Kostopoulou","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1948-1955","DOI":"10.1210\/clinem\/dgac158","article-title":"Trends in Type 1 Diabetic Ketoacidosis During COVID-19 Surges at 7 US Centers: Highest Burden on non-Hispanic Black Patients.","volume":"107","author":"A Lavik","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref52","doi-asserted-by":"crossref","first-page":"e14417","DOI":"10.1111\/dme.14417","article-title":"Increased paediatric presentations of severe diabetic ketoacidosis in an Australian tertiary centre during the COVID-19 pandemic.","volume":"38","author":"C Lawrence","year":"2021","journal-title":"Diabet. Med."},{"key":"ref53","first-page":"46-52","article-title":"Increase in blood glucose level and incidence of diabetic ketoacidosis in children with type 1 diabetes mellitus in the Daegu-Gyeongbuk area during the coronavirus disease 2019 (COVID-19) pandemic: a retrospective cross-sectional study.","volume":"39","author":"M Lee","year":"2021","journal-title":"J. Yeungnam. Med. Sci."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"e176","DOI":"10.3346\/jkms.2022.37.e176","article-title":"Comparison of Initial Presentation of Pediatric Diabetes Be-fore and During the Coronavirus Disease 2019 Pandemic Era.","volume":"37","author":"Y Lee","year":"2022","journal-title":"J. Korean Med. Sci."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"154842","DOI":"10.1016\/j.metabol.2021.154842","article-title":"Diabetic ketoacidosis in pediatric patients with type 1- and type 2 diabetes during the COVID-19 pandemic.","volume":"122","author":"C Loh","year":"2021","journal-title":"Metabolism."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"88-91","DOI":"10.20945\/2359-3997000000433","article-title":"DKA and new-onset type 1 diabetes in Brazilian children and adolescents during the COVID-19 pandemic.","volume":"66","author":"T Luciano","year":"2022","journal-title":"Arch Endocrinol. Metab."},{"key":"ref57","doi-asserted-by":"crossref","first-page":"101067","DOI":"10.1016\/j.eclinm.2021.101067","article-title":"Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: The double-wave occurrence.","volume":"39","author":"C Mameli","year":"2021","journal-title":"EClinicalMedicine."},{"key":"ref58","doi-asserted-by":"publisher","first-page":"275-284","DOI":"10.1159\/000519797","article-title":"Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic.","volume":"94","author":"B Marks","year":"2021","journal-title":"Horm. Res. Paediatr."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s13052-022-01223-8","article-title":"Peculiar characteristics of new-onset Type 1 Diabetes during COVID-19 pandemic.","volume":"48","author":"C Mastromauro","year":"2022","journal-title":"Ital. J. Pediatr."},{"key":"ref60","doi-asserted-by":"crossref","first-page":"e14640","DOI":"10.1111\/dme.14640","article-title":"The SARS-CoV-2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi-centre study of the first COVID-19 wave.","volume":"38","author":"S McGlacken-Byrne","year":"2021","journal-title":"Diabet Med. J. Br. Diabet. Assoc."},{"key":"ref61","doi-asserted-by":"publisher","first-page":"451-460","DOI":"10.1007\/s00112-020-01108-2","article-title":"Is it possible to prevent diabetic ketoacidosis at diagnosis of pediatric type 1 diabetes? Lessons from the COVID-19 pandemic.","volume":"169","author":"K M\u00f6nkem\u00f6ller","year":"2021","journal-title":"Monatsschr. Kinderheilkd."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"393-397","DOI":"10.1515\/jpem-2021-0727","article-title":"Role of the SARS-CoV-2 virus in the appearance of new onset type 1 diabetes mellitus in children in Gran Canaria, Spain.","volume":"35","author":"Y N\u00f3voa-Medina","year":"2022","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref63","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s13052-022-01264-z","article-title":"Increasing trend of type 1 diabetes incidence in the pediatric population of the Calabria region in 2019-2021.","volume":"48","author":"S Passanisi","year":"2022","journal-title":"Ital. J. Pediatr."},{"key":"ref64","doi-asserted-by":"publisher","first-page":"2870-2872","DOI":"10.2337\/dc20-1321","article-title":"Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children?","volume":"43","author":"I Rabbone","year":"2020","journal-title":"Diabetes Care."},{"key":"ref65","doi-asserted-by":"publisher","first-page":"180-185","DOI":"10.1136\/archdischild-2020-321220","article-title":"New-onset type 1 diabetes in Finnish children during the COVID-19 pandemic.","volume":"107","author":"H Salmi","year":"2022","journal-title":"Arch. Dis. Child."},{"key":"ref66","doi-asserted-by":"publisher","first-page":"208-209","DOI":"10.1093\/pch\/pxab017","article-title":"Diabetic ketoacidosis at presentation of type 1 diabetes in children in Canada during the COVID-19 pandemic.","volume":"26","author":"E Sellers","year":"2021","journal-title":"Paediatr. Child Health."},{"key":"ref67","doi-asserted-by":"publisher","first-page":"e172-e173","DOI":"10.2337\/dc20-1633","article-title":"Did the COVID-19 Lockdown Affect the Incidence of Pediatric Type 1 Diabetes in Germany?","volume":"43","author":"S Tittel","year":"2020","journal-title":"Diabetes Care."},{"key":"ref68","doi-asserted-by":"publisher","first-page":"973","DOI":"10.3390\/medicina57090973","article-title":"Increased Incidence of Type 1 Diabetes during the COVID-19 Pandemic in Romanian Children.","volume":"57","author":"A Vlad","year":"2021","journal-title":"Medicina (Kaunas)."},{"key":"ref69","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.3390\/medicina58081013","article-title":"Incidence of Type 1 Diabetes Mellitus and Characteristics of Diabetic Ketoacidosis in Children and Adolescents during the First Two Years of the COVID-19 Pandemic in Vojvodina.","volume":"58","author":"I Vorgu\u010din","year":"2022","journal-title":"Medicina (Kaunas)."},{"key":"ref70","doi-asserted-by":"publisher","first-page":"433-438","DOI":"10.1111\/pedi.13328","article-title":"increase in newly diagnosed type 1 diabetes in youth during the COVID-19 pandemic in the United States: A multi-center analysis.","volume":"23","author":"R Wolf","year":"2022","journal-title":"Pediatr. Diabetes."},{"key":"ref71","doi-asserted-by":"publisher","first-page":"127-134","DOI":"10.17219\/acem\/130359","article-title":"Diagnosis of type 1 diabetes during the SARS-CoV-2 pandemic: Does lockdown affect the incidence and clinical status of patients?","volume":"30","author":"A Zubkiewicz-Kucharska","year":"2021","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref72","doi-asserted-by":"publisher","first-page":"447-454","DOI":"10.1016\/j.dsx.2021.02.009","article-title":"The association between COVID-19 and type 1 diabetes mellitus: A systematic review.","volume":"15","author":"M Nassar","year":"2021","journal-title":"Diabetes Metab. Syndr."},{"key":"ref73","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3389\/fvets.2017.00193","article-title":"Odds Ratio or Prevalence Ratio? An Overview of Reported Statistical Methods and Appropriateness of Interpretations in Cross-sectional Stud-ies with Dichotomous Outcomes in Veterinary Medicine.","volume":"10","author":"B Martinez","year":"2017","journal-title":"Front Vet. Sci."},{"key":"ref74","doi-asserted-by":"publisher","first-page":"3231-3234","DOI":"10.1111\/jan.14528","article-title":"Using risk and odds ratios to assess effect size for meta-analysis outcome measures.","volume":"76","author":"M Alavi","year":"2020","journal-title":"J. Adv. Nurs."},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.21644723.v3","author":"E Meregildo-Rodriguez","year":"2022","journal-title":"figshare."},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.21644786.v1","article-title":"Figshare4: Supplementary materials. figshare. Online resource.","author":"E Meregildo-Rodriguez","year":"2022"},{"key":"ref77","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.21625790.v5","article-title":"Figshare2: PRISMA checklist. figshare. Online resource.","author":"E Meregildo-Rodriguez","year":"2022"},{"key":"ref78","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.21625775.v4","article-title":"Figshare1: PRISMA Flowchart. figshare. Online resource.","author":"E Meregildo-Rodriguez","year":"2022"}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/12-72\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/12-72\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/12-72\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T05:23:19Z","timestamp":1725945799000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/12-72\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,10]]},"references-count":81,"URL":"https:\/\/doi.org\/10.12688\/f1000research.128687.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.128687.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.154277.r243703","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.154277.r243707","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.154277.r243703","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.154277.r243707","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,10]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/12-72\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.141300.r172554, Carlos J. Toro-Huamanchumo, Unidad de Investigaci\u00f3n para la Generaci\u00f3n y S\u00edntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima District, Lima Region, 25 Jul 2023, version 1, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/12-72\/v1#referee-response-172554","order":0,"name":"referee-response-172554","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Edinson Dante Meregildo-Rodriguez<\/b>; \n<i>Posted: 06 Aug 2023<\/i>; The authors appreciate the reviewer's comments, which will enhance this article's quality and methodological rigor.  \n<b>The objective of evaluating the incidence of T1D is not clearly stated, especially since the title mentions that your population is children with T1D. It would seem this is not a variable as all subjects already have this diagnosis. Could you clarify this further?<\/b> \n<b>Replay:<\/b> Thank you for this valuable comment. As we stated in the last paragraph of the Introduction, we aimed to determine the impact of this pandemic on the risk (probability) of developing pediatric T1DM, DKA, severe DKA, DKA in newly diagnosed and established T1DM, etc. So, we collected studies with participants, children with and without T1DM, DKA, severe DKA, DKA in newly diagnosed and established T1DM, etc. However, we must recognize that our PECO strategy did not fully reflect this intention. Therefore, in this new version of the manuscript, we have slightly modified the structure of the PECO question, and we have described with more detail the inclusion criteria following the example of previous similar systematic reviews.  \n<b>It is not clear how clinical trials were considered as potential studies to be selected. Could you elaborate on the criteria used for this selection?<\/b> \n<b>Replay:<\/b> Thank you for this insightful observation. We included RCTs in our strategy search to carry out a broad and sensitive search. However, from the methodological and ethical point of view, and considering the exposure was &quot;COVID-19&quot; OR &quot;SARS-CoV-2&quot;, it was improbable to find any published RCT, which was confirmed by our results. All the studies were observational.  \n<b>When you state &quot;We excluded case reports, case series, duplicated publications, and papers in which most patients were &gt;18 years old or had other types of diabetes mellitus&quot;, could you specify what you mean by &quot;most&quot;? Does this refer to &gt;50%? &gt;75%? This point needs to be explicitly clarified.<\/b> \n<b>Replay:<\/b> Thank you for this comment. According to The Cochrane Handbook, the criteria for considering the population included in studies in a systematic review should be sufficiently broad to encompass the likely diversity of studies and the likely scenarios in which the interventions will be used, but narrow enough to ensure that a meaningful answer can be obtained when studies are considered together. A cutoff of more than 50% ensures that most participants in the included studies are children, which increases the likelihood that the results are relevant to children. Then, In the new version of the manuscript, we have included a small paragraph indicating that we considered a &gt;50% cutoff for excluding studies.  \n<b>The process of how four independent reviewers examined the articles and a fifth investigator resolved discrepancies is unclear, especially given that there are only four authors listed in total. Please note that only three authors are listed on PROSPERO.<\/b> \n<b>Replay:<\/b> Thank you for this insightful comment. You are right. Consequently, we have made the pertinent corrections in this revised manuscript version. Furthermore, we have updated the protocol in PROSPERO, including the four authors.  \n<b>The eligibility criteria need to be more precisely defined. The PECO question seems more oriented towards assessing whether having COVID-19 is associated with any of those outcomes, and not whether the incidence of each of the outcomes increased during the pandemic vs. pre-pandemic. In this sense, rather than formulating a PECO, it may be more useful to describe the inclusion criteria for studies in detail (as some previous systematic reviews have done).<\/b> \n<b>Replay:<\/b> Thank you for this accurate comment. We have made the following modifications in our manuscript: 1) we have modified the Population component of our PECO question, and 2) described with more detail the inclusion criteria following the example of previous similar systematic reviews.  \n<b>Please clarify why you preferred to use OR instead of RR. <\/b> \n<b>Replay:<\/b> Thank you for this insightful comment. Of the 46 studies included in this review, six studies were cross-sectional studies (CSS), two papers were case-control studies (CCS), and thirty-eight documents were prospective or retrospective cohort studies (PCS, RCS). The only measure of association that these study designs have is the OR. Consequently, we used OR, not RR.  \n<b>The statistical procedure for obtaining MD for the duration of hospital stay is not mentioned. Could you provide more detail on this?<\/b> \n<b>Replay:<\/b> Thank you for this valuable comment. In this revised version of our manuscript, we have modified the respective paragraph detailing the statistical method used for obtaining MD and SD. Furthermore, we have included the corresponding references that support these statements.  \n<b>I strongly recommend presenting the complete results of the NOS, not just the final outcome.<\/b> \n<b>Replay:<\/b> Thank you for this important. In this revised version of our manuscript, we have modified &quot;Table 2. Bias assessment of the included studies,&quot; presenting the complete Newcastle-Ottawa Scale (NOS) tool.","URL":"https:\/\/f1000research.com\/articles\/12-72\/v2#referee-comment-10037","order":1,"name":"referee-comment-10037","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.154277.r243703, Stefano Passanisi, University of Messina, Messina, 19 Feb 2024, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/12-72\/v2#referee-response-243703","order":2,"name":"referee-response-243703","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.154277.r243707, Fatma \u00d6zg\u00fc\u00e7 \u00c7\u00f6mlek, Pediatric Endocrinology, Sel\u00e7uk University Medical Facutly, Konya, Se\u00e7uklu, 10 Sep 2024, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/12-72\/v2#referee-response-243707","order":3,"name":"referee-response-243707","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}