Non-COVID-19-related deaths among people with diabetes increased during the pandemic, and women and children suffered more from related complications, according to a global study review published in The Lancet Diabetes and Endocrinology.

The review, commissioned by the World Health Organization (WHO) looked at 138 studies comparing pre-pandemic to during-pandemic periods in North America (39), Western Europe (39), Asia (17), Eastern Europe (14), South America (four), Egypt (one), Australia (one) and multiple regions (33).

“What we found overall was a fairly negative impact on diabetes outcomes,” said co-lead author Jamie Hartmann-Boyce, Assistant Professor of health policy and promotion at the University of Massachusetts-Amherst’s School of Public Health and Health Sciences.

The review also found a startling increase in diabetes-related admissions to paediatric ICUs, as well as a rise in cases of diabetic ketoacidosis (DKA) among children and adolescents.

Some of the cases were due to new-onset diabetes, meaning DKA -- a serious, potentially life-threatening complication of diabetes -- coincided with the diabetes diagnosis. There was no rise in the frequency or severity of DKA among adults.

In addition to an increase in deaths, “the data on paediatric ICU admissions and paediatric diabetes ketoacidosis is probably the most striking thing that comes out of this review,” Hartmann-Boyce said. “It was very consistent across countries, and a paediatric ICU admission is a major event for kids and their families.”

The team also focussed on the pandemic’s indirect impacts on diabetes management.

“We know that not getting your eyes screened regularly if you have diabetes is a problem and leads to more sight loss,” Hartmann-Boyce said.

“And we saw diabetes-related mortality and all-cause mortality increasing in England during the first wave that wasn’t attributed to COVID but was probably related to reduced access to health care and reduced health care utilisation.”

The researchers note that there were more new cases of Type 1 diabetes than would have been expected, and children newly diagnosed with Type 1 diabetes were much sicker than during non-pandemic periods.

Much less common than Type 2 diabetes, Type 1 diabetes is an autoimmune disease that is usually diagnosed in childhood but can occur at any age.

The negative impacts were most pronounced for females, and younger people, according to the review.

The team urged that next pandemic planning must include care for people living with diabetes, particularly for those from less advantaged groups.