Evidence mapPaperPMID 42445883Full record

ArticleFrontiers in endocrinology2026

Persistently increased frequency of diabetic ketoacidosis in new-onset type 1 diabetes in Polish children: nationwide analysis 2019-2022.

Arkadiusz Michalak, Barbara Pernak, Jędrzej Chrzanowski, Iwona Pietrzak, Iwona Beń-Skowronek, Artur Bossowski, Agata Chobot, Maria Bednarska, Katarzyna Dżygało, Wojciech Fendler and 25 more

Abstract readMulticenter Study
In one paragraph

Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

35 authors.

Arkadiusz Michalak *Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Łódź, Łódź, Poland.
Barbara Pernak *Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland.
Jędrzej ChrzanowskiDepartment of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland.
Iwona PietrzakDepartment of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Łódź, Łódź, Poland.
Iwona Beń-SkowronekDepartment of Pediatric Endocrinology and Diabetology, Medical University in Lublin, Lublin, Poland.
Artur BossowskiDepartment of Pediatrics, Endocrinology and Diabetology with Cardiology Unit, Medical University of Białystok, Białystok, Poland.
Agata ChobotDepartment of Pediatrics, University Clinical Hospital in Opole, Opole, Poland.
Maria BednarskaDepartment of Pediatrics, University Clinical Hospital in Opole, Opole, Poland.
Katarzyna DżygałoDepartment of Paediatric Diabetology and Paediatrics, Medical University of Warsaw, Warsaw, Poland.
Wojciech FendlerDepartment of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland.
Barbara Głowińska-OlszewskaDepartment of Pediatrics, Endocrinology and Diabetology with Cardiology Unit, Medical University of Białystok, Białystok, Poland.
Martyna Górnicka de AlmeidaDepartment of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland.
Anita Horodnicka-JózwaDepartment of Pediatrics, Endocrinology and Diabetology, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Katarzyna Jakubek-KipaDepartment of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College University of Rzeszów, Rzeszów, Poland.
Przemysława Jarosz-ChobotDepartment of Children's Diabetology and Lifestyle Medicine, Medical University of Silesia, Katowice, Poland.
Anna KąckaDepartment of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
Katarzyna MarcinkiewiczDepartment of Pediatrics, Endocrinology and Diabetology, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Artur MazurDepartment of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College University of Rzeszów, Rzeszów, Poland.
Małgorzata MyśliwiecDepartment of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, Gdańsk, Poland.
Joanna NazimDepartment of Pediatric Endocrinology, Jagiellonian University Medical College, Kraków, Poland.
Barbara Wasyl-NawrotDepartment of Pediatric Endocrinology, Jagiellonian University Medical College, Kraków, Poland.
Elżbieta NiechciałDepartment of Pediatric Diabetes, Auxology and Obesity, Poznań University of Medical Sciences, Poznań, Poland.
Anna NoczyńskaDepartment of Pediatrics, Endocrinology, Diabetology and Metabolic Diseases, Wrocław Medical University, Wrocław, Poland.
Ewa RusakDepartment of Children's Diabetology and Lifestyle Medicine, Medical University of Silesia, Katowice, Poland.
Sebastian SegetDepartment of Children's Diabetology and Lifestyle Medicine, Medical University of Silesia, Katowice, Poland.
Monika SeifertDepartment of Pediatrics, Endocrinology, Diabetology and Metabolic Diseases, Wrocław Medical University, Wrocław, Poland.
Elżbieta Skotarczyk-KowalskaDepartment of Children Endocrinology and Diabetology, Regional Polyclinical Hospital, Kielce, Poland.
Anna SkowronekDepartment of Pediatric Endocrinology and Diabetology, Medical University in Lublin, Lublin, Poland.
Lidia GroeleDepartment of Paediatric Diabetology and Paediatrics, Medical University of Warsaw, Warsaw, Poland.
Paulina WaisDepartment of Pediatric Diabetes, Auxology and Obesity, Poznań University of Medical Sciences, Poznań, Poland.
Mieczysław WalczakDepartment of Pediatrics, Endocrinology and Diabetology, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Anna Wołoszyn-DurkiewiczDepartment of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, Gdańsk, Poland.
Marta Wysocka-MincewiczDepartment of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland.
Agnieszka Zubkiewicz-KucharskaDepartment of Pediatrics, Endocrinology, Diabetology and Metabolic Diseases, Wrocław Medical University, Wrocław, Poland.
Agnieszka SzadkowskaDepartment of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Łódź, Łódź, Poland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Aims: Global data show an increase in the rate of diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) onset during the COVID-19 pandemic, but its effect on severity remain unclear. This study assessed pre-pandemic, pandemic, and post-pandemic DKA frequency in Polish children with new-onset T1D and evaluated the pandemic's impact on DKA incidence and severity. Methods: This multicenter national retrospective study collected an anonymized list of all new-onset T1D cases in Polish children (<18y.o.) diagnosed based on clinical presentation (diabetes diagnosed based on random blood glucose >=200mg/dl and symptoms, no suspicion of other type of diabetes). Results: We analyzed 7192 children with a new-onset diabetes, and after applying the predefined inclusion and exclusion criteria, 6543 cases were ultimately included in the final analysis. Overall, 54.5% presented with DKA. Frequency increased from 47.9% in 2019 to 58.6% in 2020 (p<0.0001) and decreased to 54.0% in 2022. Observed pandemic DKA (56.8%) exceeded model predictions (47.5%; p=0.0041). The additional impact of COVID-19 was estimated at a +9.4 percentage-point increase, with a 95% CI of +9.1 to 9.6%, with DKA predicted and observed rates converging by the end of the pandemic. During the pandemic, children were also more likely to present with moderate or severe DKA compared with the rest of the study period, with a subsequent decrease in severity after the pandemic. Conclusions: DKA frequency increased across the study period, with a peak during the pandemic. This findings should be interpreted in the context of global epidemiological data, where the prevalence of DKA at diagnosis of type 1 diabetes remains high and varies widely between countries, reaching around 50% in some populations. Therefore, coordinated country-level actions aimed at improving awareness of early diabetes symptoms are needed to reduce the persistently high rate of DKA.

Indexed as

COVID-19Diabetes Mellitus, Type 1Diabetic KetoacidosisAdolescentChildChild, PreschoolFemaleHumansIncidenceInfantMalePandemicsPolandRetrospective StudiesSARS-CoV-2diabetes mellitusdiabetic ketoacidosisepidemiologynationwide active surveillancepandemic (COVID19)

Identifiers

PMID42445883
PMCPMC13357116

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.