The beginning of the COVID-19 pandemic saw a rise in cases of diabetic ketoacidosis (DKA) — a life-threatening condition marked by high levels of glucose and chemicals called ketones in the blood — in children with new-onset type 1 diabetes, according to a new study published in the journal Diabetic Medicine.
Researchers in Britain looked at rates of hospital admission for DKA in children with new-onset type 1 over a yearlong period — nine months before the start of the COVID-19 pandemic, and three months at the start of it — at a multicenter diabetes network in London. During the first nine-month period, a total of 30 children presented with new-onset type 1, whether or not they had DKA. During the second three-month period, 17 children did so.
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DKA more common, severe in new-onset T1D during pandemic
When it came to DKA, it was more common and more severe during the first three months of the pandemic in children with new-onset type 1. During the initial nine-month pre-pandemic period, 13% of children with new-onset type 1 had mild DKA, 6.7% had moderate DKA, and 10% had severe DKA — for a total of about 30% presenting with DKA. During the first 3 months of the pandemic, 5.9% of children with new-onset type 1 had mild DKA, 24% had moderate DKA, and 47% had severe DKA — for a total of about 77% presenting with DKA.
There were some notable differences in certain traits among the children in the study. Among children with new-onset type 1 during the first three months of the pandemic, 33% of those with a family history of diabetes presented with DKA, while 100% of those without a family history of diabetes presented with DKA. This stark difference illustrates how families that are unfamiliar with type 1 diabetes may be less likely to recognize signs of the illness, waiting until the child develops severe illness before seeking medical attention. Before the onset of the pandemic, children with severe DKA tended to be much younger than those without severe DKA at the time of new-onset type 1 — an average of 3.9 years old for those with severe DKA, compared with an average of 12.2 years old. But during the first three months of the pandemic, this age gap narrowed to the point of statistical insignificance — those with severe DKA had an average age of 10.1, while those without severe DKA had an average age of 11.2.
Not surprisingly given the much higher rate of DKA, children with new-onset type 1 during the first three months of the pandemic tended to have a higher A1C level (a measure of long-term blood glucose control) than during the previous nine months — an average of 13.0%, compared with 10.4% before the pandemic.
“The COVID-19 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes,” the researchers concluded. “Whatever the context, young people with suspected new-onset type 1 diabetes should be referred for urgent clinical review.”
The researchers wrote that it’s unclear to what extent COVID-19 directly led to the increase seen in DKA, and to what extent the increase was due to other factors like being less likely to seek out medical care during the pandemic. But they noted that the one child who tested positive for COVID-19 on two different types of tests (antibody and PCR) at the time of admission also experienced the most severe effects of DKA, going into cardiac arrest and having extremely acidic blood. Due to seasonal variation in new-onset type 1 and the small sample size of the study, the researchers couldn’t determine whether the pandemic was actually linked to an increase in new cases of diabetes.
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