Severe DKA cases increase in children with new-onset type 1 diabetes during COVID-19
Children in the United Kingdom presented with more severe diabetic ketoacidosis cases during the first 3 months of the COVID-19 pandemic compared with the preceding 9 months, according to findings published in Diabetic Medicine.
“Over a 1-year period, presentations of newly diagnosed childhood-onset type 1 diabetes were more severe during the first COVID-19 wave compared with the 9 preceding pre-pandemic months,” Sinéad M. McGlacken-ByrneMB, BCh, BAO, MEd, a pediatric endocrinologist at Great Ormond Street Hospital in London, and colleagues wrote in a study published in Diabetic Medicine. “This was evidenced by a lower pH at diagnosis, a higher presenting HbA1c, and a greater risk of developing DKA and severe DKA. These observations are consistent with other reports documenting the higher rates of DKA in both pediatric and adult patient populations during the first months of the pandemic.”
Researchers analyzed data on new-onset type 1 diabetes in children at four inpatient units of the North Central London Paediatric Diabetes Network. Cases from July 2019 to March 22, 2020, were labeled as pre-pandemic, and new presentations from March 23 to June 30, 2020, were categorized as taking place during the first COVID-19 wave. Clinical and biochemical data were extracted from electronic medical records. Researchers compared demographic data, the severity of DKA as measured by pH, DKA admissions requiring ICU admission, electrolyte imbalance and HbA1c from pre-pandemic to the first COVID-19 wave.
There were 30 children who presented with new-onset type 1 diabetes before COVID-19 and 17 who presented during the first wave. Mean pH was lower during COVID-19 compared with pre-pandemic (7.09 vs. 7.3; P = .001), and the first HbA1c measurement was higher during the pandemic compared with before (13% vs. 10.4%; P = .008). There was no significant increase in ICU admission for DKA during the pandemic.
There were more children presenting with DKA during the pandemic compared with before. Mild DKA was observed in 13% of children pre-pandemic and 5.9% during the pandemic, moderate DKA increased from 6.7% of presenting children before the pandemic to 24% during the pandemic, and severe DKA increased from 10% pre-pandemic to 47% during the first COVID-19 wave (P = .002).
During the pandemic, DKA presentations in children with a family history of type 1 diabetes were less frequent compared with those without a family history (33.3% vs. 100%; P = .006). Children presenting with severe DKA were younger pre-pandemic compared with those not in severe DKA (mean age, 3.9 years vs. 12.2 years; P < .001). During the pandemic, there was no significant difference in age between those with severe and nonsevere DKA.
“It is paramount that pediatricians and primary care providers are aware of this link between COVID-19 and new-onset diabetes severity,” the researchers wrote. “This is particularly true in view of the ongoing disruption to usual clinical care caused by the COVID-19 pandemic; whatever the context, children and young people with suspected new-onset type 1 diabetes require urgent clinical review.”