{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:32:42Z","timestamp":1760146362924,"version":"build-2065373602"},"reference-count":67,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Diabetic ketoacidosis (DKA) is a common complication of type 1 diabetes mellitus (T1DM) in children. Here, we explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on the occurrence and severity of DKA in children in southern Croatia. Materials and Methods: The demographics and clinical and laboratory findings of all children and adolescents aged 0\u201318 years diagnosed with DKA and admitted to the pediatric intensive care unit (PICU) of the University Hospital of Split, Croatia from January 2013 to May 2023 were retrospectively collected. The participants were divided into two groups: (1) the pre-pandemic group (presenting before mid-March 2020) and (2) the pandemic group (presenting afterwards). Results: A total of 91 patients were included, 68 in the pre-pandemic and 23 in the pandemic group. The admission rate was similar (&lt;1 patient per month) in both groups. In comparison to pre-pandemic patients, which mostly presented during the summer (52.9%) and winter seasons (23.5%), most pandemic cases occurred in spring (34.8%) and fall (30.4%, p = 0.002). No significant differences between the groups were identified in the severity of DKA, as reflected either by mean pH and median bicarbonate levels or by the proportion of patients with severe DKA. Nevertheless, HbA1c and triglycerides were significantly higher in the pandemic group (12.56% vs. 11.02%, p = 0.002 and 4.95 mmol\/L vs. 2.8 mmol\/L, p = 0.022, respectively) indicating poorer long-term glycemia. DKA complications were, overall, rare and without significant differences between the groups. Conclusions: The COVID-19 pandemic did not impact overall frequency or severity of DKA in children in southern Croatia. While the seasonal changes in DKA occurrence and a poorer long-term glycemia in pandemic patients may have been influenced by COVID-19 outbreaks and the imposed anti-pandemic measures, further studies are needed to determine if this was a temporary pandemic-related phenomenon or if this trend would persist in the future.<\/jats:p>","DOI":"10.3390\/medicina60111775","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T10:49:52Z","timestamp":1730285392000},"page":"1775","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the COVID-19 Pandemic on Diabetic Ketoacidosis Patients Treated in a Pediatric Intensive Care Unit: A Single-Center Cross-Sectional Study"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7279-0345","authenticated-orcid":false,"given":"Eva","family":"Perak","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7610-4891","authenticated-orcid":false,"given":"Dina","family":"Mrcela","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9469-9278","authenticated-orcid":false,"given":"Josko","family":"Markic","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia"},{"name":"School of Medicine, University of Split, Soltanska 2a, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/pedi.13406","article-title":"ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State","volume":"23","author":"Glaser","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1038\/s41572-020-0165-1","article-title":"Diabetic Ketoacidosis","volume":"6","author":"Dhatariya","year":"2020","journal-title":"Nat. Rev. Dis. Primer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S0168-8227(01)00328-X","article-title":"Severity at Onset of Childhood Type 1 Diabetes in Countries with High and Low Incidence of the Condition","volume":"55","author":"Samuelsson","year":"2002","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.2337\/dc21-2227","article-title":"Frequency of Ketoacidosis at Diagnosis of Pediatric Type 1 Diabetes Associated with Socioeconomic Deprivation and Urbanization: Results from the German Multicenter DPV Registry","volume":"45","author":"Auzanneau","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"B75","DOI":"10.1007\/PL00002958","article-title":"Europe and Diabetes Geographical Variation of Presentation at Diagnosis of Type I Diabetes in Children: The EURODIAB Study. European and Dibetes","volume":"44","author":"Patterson","year":"2001","journal-title":"Diabetologia"},{"key":"ref_6","first-page":"43","article-title":"Clinical Picture of Childhood Type 1 Diabetes Mellitus in the Eastern Province of Saudi Arabia","volume":"2","author":"Kulaylat","year":"2001","journal-title":"Pediatr. Diabetes"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1038\/nrendo.2016.15","article-title":"Diabetic Emergencies\u2014Ketoacidosis, Hyperglycaemic Hyperosmolar State and Hypoglycaemia","volume":"12","author":"Umpierrez","year":"2016","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_8","unstructured":"Stirparo, G., Kacerik, E., Andreassi, A., Pausilli, P., Cortellaro, F., Coppo, A., Migliari, M., Albonico, A., Sechi, G.M., and Zoli, A. (2023). Emergency Department Waiting-Time in the Post Pandemic Era: New Organizational Models, a Challenge for the Future. Acta Biomed. Atenei Parm., 94."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nijman, R.G., Honeyford, K., Farrugia, R., Rose, K., Bognar, Z., Buonsenso, D., Da Dalt, L., De, T., Maconochie, I.K., and Parri, N. (2022). Presentations of Children to Emergency Departments across Europe and the COVID-19 Pandemic: A Multinational Observational Study. PLoS Med., 19.","DOI":"10.1371\/journal.pmed.1003974"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.ajem.2020.11.037","article-title":"Characterizing Pediatric Emergency Department Visits during the COVID-19 Pandemic","volume":"41","author":"Pines","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1001\/jama.2020.9972","article-title":"Admissions to Veterans Affairs Hospitals for Emergency Conditions During the COVID-19 Pandemic","volume":"324","author":"Baum","year":"2020","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5112","DOI":"10.1002\/jmv.27996","article-title":"The Global Impact of COVID-19 Pandemic on the Incidence of Pediatric New-Onset Type 1 Diabetes and Ketoacidosis: A Systematic Review and Meta-Analysis","volume":"94","author":"Rahmati","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1149","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","volume":"93","author":"Elgenidy","year":"2023","journal-title":"Pediatr. Res."},{"key":"ref_14","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":"Lawrence","year":"2021","journal-title":"Diabet. Med. J. Br. Diabet. Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Alfayez, O.M., Aldmasi, K.S., Alruwais, N.H., Bin Awad, N.M., Al Yami, M.S., Almohammed, O.A., and Almutairi, A.R. (2022). Incidence of Diabetic Ketoacidosis Among Pediatrics with Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.856958"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"801","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":"Kamrath","year":"2020","journal-title":"JAMA"},{"key":"ref_17","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":"Drew","year":"2021","journal-title":"Diabet. Med. J. Br. Diabet. Assoc."},{"key":"ref_18","unstructured":"Cherubini, V., Marino, M., Scaramuzza, A.E., Tiberi, V., Bobbio, A., Delvecchio, M., Piccinno, E., Ortolani, F., Innaurato, S., and Felappi, B. (2022). The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020. Front. Endocrinol., 13."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Vorgu\u010din, I., Savin, M., Stankovi\u0107, \u0110., Miljkovi\u0107, D., Ili\u0107, T., Simi\u0107, D., Vrebalov, M., Milanovi\u0107, B., Bari\u0161i\u0107, N., and Stojanovi\u0107, V. (2022). 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. Med. Kaunas Lith., 58.","DOI":"10.3390\/medicina58081013"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Rusak, E., Seget, S., Macherski, M., Furga\u0142, N., Dy\u015b, P., and Jarosz-Chobot, P. (2022). Has the COVID-19 Pandemic Affected the Prevalence of Diabetic Ketoacidosis in Polish Children with Newly Diagnosed Type 1 Diabetes? An Example of the Largest Polish Pediatric Diabetes Center (Upper Silesia\u2014Katowice, Poland). Healthcare, 10.","DOI":"10.3390\/healthcare10020348"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Boboc, A.A., Novac, C.N., Ilie, M.T., Ie\u0219anu, M.I., Galo\u0219, F., B\u0103lgr\u0103dean, M., Berghea, E.C., and Ionescu, M.D. (2021). The Impact of SARS-CoV-2 Pandemic on the New Cases of T1DM in Children. A Single-Centre Cohort Study. J. Pers. Med., 11.","DOI":"10.3390\/jpm11060551"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fignani, D., Licata, G., Brusco, N., Nigi, L., Grieco, G.E., Marselli, L., Overbergh, L., Gysemans, C., Colli, M.L., and Marchetti, P. (2020). SARS-CoV-2 Receptor Angiotensin I-Converting Enzyme Type 2 (ACE2) Is Expressed in Human Pancreatic \u03b2-Cells and in the Human Pancreas Microvasculature. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.596898"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1038\/s42255-021-00347-1","article-title":"SARS-CoV-2 Infects and Replicates in Cells of the Human Endocrine and Exocrine Pancreas","volume":"3","author":"Conzelmann","year":"2021","journal-title":"Nat. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e000884","DOI":"10.1136\/bmjpo-2020-000884","article-title":"Presentation of Newly Diagnosed Type 1 Diabetes in Children and Young People during COVID-19: A National UK Survey","volume":"4","author":"Ng","year":"2020","journal-title":"BMJ Paediatr. Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jpeds.2020.05.004","article-title":"Unintended Consequences of Coronavirus Disease-2019: Remember General Pediatrics","volume":"223","author":"Cherubini","year":"2020","journal-title":"J. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","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":"Bogale","year":"2021","journal-title":"Endocrinol. Diabetes Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2870","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":"Rabbone","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"264","DOI":"10.4274\/jcrpe.galenos.2023.2022-11-4","article-title":"The Effect of the SARS-CoV-2 Pandemic on Presentation with Diabetic Ketoacidosis in Children with New Onset Type 1 Diabetes Mellitus","volume":"15","author":"Jalilova","year":"2023","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"783","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":"Han","year":"2021","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Alaqeel, A., Aljuraibah, F., Alsuhaibani, M., Huneif, M., Alsaheel, A., Dubayee, M.A., Alsaedi, A., Bakkar, A., Alnahari, A., and Taha, A. (2021). The Impact of COVID-19 Pandemic Lockdown on the Incidence of New-Onset Type 1 Diabetes and Ketoacidosis Among Saudi Children. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.669302"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Leiva-Gea, I., Fern\u00e1ndez, C.A., Cardona-Hernandez, R., Lozano, M.F., Bah\u00edllo-Curieses, P., Arroyo-D\u00edez, J., Le\u00f3n, M.C., Mart\u00edn-Fr\u00edas, M., Barreiro, S.C., and Delgado, A.M. (2022). Increased Presentation of Diabetic Ketoacidosis and Changes in Age and Month of Type 1 Diabetes at Onset during the COVID-19 Pandemic in Spain. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154338"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s13052-023-01448-1","article-title":"Prevalence and Clinical Features of Severe Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: A 5-Year Monocentric Experience","volume":"49","author":"Passanisi","year":"2023","journal-title":"Ital. J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kiral, E., Kirel, B., Havan, M., Keskin, M., Karaoglan, M., Yildirim, A., Kangin, M., Talay, M.N., Urun, T., and Altug, U. (2022). Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting with Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.926013"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e3506","DOI":"10.1002\/dmrr.3506","article-title":"Higher Rates of Diabetic 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":"Alkandari","year":"2022","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"McCluskey, C.K., Zee-Cheng, J.E., Klein, M.J., Scanlon, M.C., Rotta, A.T., Remy, K.E., Carroll, C.L., and Shein, S.L. (2022). The Temporal Relationship Between Local School Closure and Increased Incidence of Pediatric Diabetic Ketoacidosis. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.812265"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1186\/s13054-021-03779-z","article-title":"In the Eye of the Storm: Impact of COVID-19 Pandemic on Admission Patterns to Paediatric Intensive Care Units in the UK and Eire","volume":"25","author":"Kanthimathinathan","year":"2021","journal-title":"Crit. Care Lond. Engl."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Lah Tomuli\u0107, K., Matko, L., Verbi\u0107, A., Milardovi\u0107, A., Severinski, S., Koli\u0107, I., Baraba Dekani\u0107, K., \u0160erifi, S., and Butorac Ahel, I. (2022). Epidemiologic Characteristics of Children with Diabetic Ketoacidosis Treated in a Pediatric Intensive Care Unit in a 10-Year-Period: Single Centre Experience in Croatia. Med. Kaunas Lith., 58.","DOI":"10.3390\/medicina58050638"},{"key":"ref_38","unstructured":"Vinkovic, M., Krnic, N., Bogdanic, A., Dumic Kubat, K., Braovac, D., and Spehar Uroic, A. (2022). Ketoacidosis and Age Distribution in New-Onset Type 1 Diabetes During Covid-19 Pandemic. Horm. Res. Paediatr., 95."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Burcul, I., Arambasic, N., Polic, B., Kovacevic, T., Bartulovic, I., Catipovic Ardalic, T., and Markic, J. (2019). Characteristics of Children with Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: Two-Center Cross-Sectional Study in Croatia. Med. Kaunas Lith., 55.","DOI":"10.3390\/medicina55070362"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e1150","DOI":"10.1542\/peds.2012-2443","article-title":"Development of Heart and Respiratory Rate Percentile Curves for Hospitalized Children","volume":"131","author":"Bonafide","year":"2013","journal-title":"Pediatrics"},{"key":"ref_41","unstructured":"(2024, October 04). Blood Pressure Levels for Boys and Girls by Age and Height Percentile, Available online: https:\/\/www.nhlbi.nih.gov\/files\/docs\/guidelines\/child_tbl.pdf."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1948","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":"Lavik","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_43","unstructured":"(2024, September 21). Croatia\u2014COVID-19 Overview\u2014Johns Hopkins. Available online: https:\/\/Coronavirus.Jhu.Edu\/Region\/Croatia."},{"key":"ref_44","unstructured":"(2024, September 21). Coronavirus Epidemic in the Republic of Croatia [in Croatian], Available online: https:\/\/Civilna-Zastita.Gov.Hr\/UserDocsImages\/CIVILNA%20ZA%C5%A0TITA\/PDF_ZA%20WEB\/Bro%C5%A1ura-COVID2.Pdf."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"5123197","DOI":"10.1155\/2023\/5123197","article-title":"Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic","volume":"2023","author":"Azova","year":"2023","journal-title":"Pediatr. Diabetes"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e132809","DOI":"10.5812\/ijem-132809","article-title":"Diabetic Ketoacidosis in Children Before and During COVID-19 Pandemic: A Cross-Sectional Study","volume":"21","author":"Ordooei","year":"2023","journal-title":"Int. J. Endocrinol. Metab."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.diabet.2013.11.001","article-title":"Ketoacidosis at Diagnosis of Type 1 Diabetes in French Children and Adolescents","volume":"40","author":"Choleau","year":"2014","journal-title":"Diabetes Metab."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1530\/EJE-11-0376","article-title":"Finnish Paediatric Diabetes Register Family History of Diabetes and Distribution of Class II HLA Genotypes in Children with Newly Diagnosed Type 1 Diabetes: Effect on Diabetic Ketoacidosis","volume":"165","author":"Hekkala","year":"2011","journal-title":"Eur. J. Endocrinol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"371","DOI":"10.4266\/acc.2023.00038","article-title":"Impact of the COVID-19 Pandemic on Diabetic Ketoacidosis Management in the Pediatric Intensive Care Unit","volume":"38","author":"Kahveci","year":"2023","journal-title":"Acute Crit. Care"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1111\/pedi.13338","article-title":"Glycated Hemoglobin at Diagnosis of Type 1 Diabetes and at Follow-up in Children and Adolescents during the COVID-19 Pandemic in Germany","volume":"23","author":"Kamrath","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.dsx.2020.07.016","article-title":"Impact of Lockdown in COVID 19 on Glycemic Control in Patients with Type 1 Diabetes Mellitus","volume":"14","author":"Verma","year":"2020","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"108468","DOI":"10.1016\/j.diabres.2020.108468","article-title":"Type 1 Diabetes and COVID-19: The \u201cLockdown Effect\u201d","volume":"170","author":"Aragona","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"108988","DOI":"10.1016\/j.diabres.2021.108988","article-title":"Has COVID-19 Lockdown Improved Glycaemic Control in Pediatric Patients with Type 1 Diabetes? An Analysis of Continuous Glucose Monitoring Metrics","volume":"178","author":"Lombardo","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Nwosu, B.U., Al-Halbouni, L., Parajuli, S., Jasmin, G., Zitek-Morrison, E., and Barton, B.A. (2021). COVID-19 Pandemic and Pediatric Type 1 Diabetes: No Significant Change in Glycemic Control During the Pandemic Lockdown of 2020. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.703905"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Hakonen, E., Varimo, T., Tuomaala, A.-K., Miettinen, P.J., and Pulkkinen, M.-A. (2022). The Effect of COVID-19 Lockdown on the Glycemic Control of Children with Type 1 Diabetes. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03115-6"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"110809","DOI":"10.1016\/j.diabres.2023.110809","article-title":"Diabetes Care Practices and Outcomes in 40.000 Children and Adolescents with Type 1 Diabetes from the SWEET Registry during the COVID-19 Pandemic","volume":"202","author":"Chobot","year":"2023","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1177\/0009922815617975","article-title":"Incidence, Trends, and Outcomes of Cerebral Edema Among Children with Diabetic Ketoacidosis in the United States","volume":"55","author":"Patel","year":"2016","journal-title":"Clin. Pediatr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.jpeds.2004.12.041","article-title":"Population-Based Study of Incidence and Risk Factors for Cerebral Edema in Pediatric Diabetic Ketoacidosis","volume":"146","author":"Lawrence","year":"2005","journal-title":"J. Pediatr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1056\/NEJM200101253440404","article-title":"Risk Factors for Cerebral Edema in Children with Diabetic Ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics","volume":"344","author":"Glaser","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/pedi.12701","article-title":"ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar State","volume":"19","author":"Wolfsdorf","year":"2018","journal-title":"Pediatr. Diabetes"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1136\/adc.81.4.318","article-title":"Causes of Death in Children with Insulin Dependent Diabetes 1990-96","volume":"81","author":"Edge","year":"1999","journal-title":"Arch. Dis. Child."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/pedi.13152","article-title":"Brain Injury in Children with Diabetic Ketoacidosis: Review of the Literature and a Proposed Pathophysiologic Pathway for the Development of Cerebral Edema","volume":"22","author":"Azova","year":"2021","journal-title":"Pediatr. Diabetes"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"22","DOI":"10.2337\/diacare.13.1.22","article-title":"Intracerebral Crises during Treatment of Diabetic Ketoacidosis","volume":"13","author":"Rosenbloom","year":"1990","journal-title":"Diabetes Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/S2213-8587(22)00278-9","article-title":"The Impact of the COVID-19 Pandemic on Diabetes Services: Planning for a Global Recovery","volume":"10","author":"Khunti","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Cerove\u010dki, I., and \u0160vajda, M. (2021). COVID-19 Pandemic Influence on Diabetes Management in Croatia. Front. Clin. Diabetes Healthc., 2.","DOI":"10.3389\/fcdhc.2021.704807"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"108838","DOI":"10.1016\/j.diabres.2021.108838","article-title":"Effectiveness of Ketoacidosis Prevention Campaigns at Diagnosis of Type 1 Diabetes in Children: A Systematic Review and Meta-Analysis","volume":"175","author":"Cherubini","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_67","first-page":"1","article-title":"Preliminary Results of Public Health Prevention Program for Diabetic Ketoacidosis in Children and Adolescent","volume":"91","year":"2019","journal-title":"Horm. Res. Paediatr."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1775\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:24:08Z","timestamp":1760113448000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1775"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,30]]},"references-count":67,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["medicina60111775"],"URL":"https:\/\/doi.org\/10.3390\/medicina60111775","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2024,10,30]]}}}