Increased severity of presentation signs in children with newly diagnosed Type 1 Diabetes during the COVID-19 pandemic: A tertiary center experience.

INTRODUCTION: Diabetic ketoacidosis (DKA) is an important complication of Type 1 Diabetes Mellitus (T1DM) which is worsened when the diagnosis of T1DM is delayed. The aim of this study was to evaluate the presentation patterns, severity, autoantibody status and seasonal variability of newly diagnosed T1DM patients during the pandemic period of two years compared to those in the pre-pandemic period.

METHODS: In this single tertiary center retrospective cohort study newly diagnosed T1DM patients were grouped as pre-pandemic and pandemic period. Age, gender, the month of diagnosis, hemoglobinA1c (HbA1c), venous blood gas parameters, duration of symptoms, glutamic-acid-decarboxylase-antibody (anti GAD), islet-cell antibody (ICA) and insulin autoantibody (IAA) levels were recorded. The data obtained were compared between the groups.

RESULTS: Number of patients presenting with DKA was significantly higher during the pandemic period (92 (65.7%) vs. 62 (40.8%) patients, p<0.001). In terms of clinical severity of DKA, pH, and HCO3 levels were lower during the pandemic period (p<0.001), while the number of patients presenting with severe DKA was significantly higher during the pandemic period (41 (44.6%) vs. 17 (27.4%) patients, p=0.031). ICA positivity was significantly higher in patients admitted during the pandemic period (47 (36.4%) vs. 21 patients (16.9%), p<0.001), especially in the second year of the pandemic (p<0.001). Anti GAD-ICA co-positivity was significantly higher in patients admitted during the pandemic period and also in second year of the pandemic (p<0.001).

CONCLUSION: DKA rates increased in newly diagnosed T1DM cases during the pandemic. Despite the relaxation of bans, the second year of the pandemic also saw increased rates of DKA and severe DKA compared to the pre-pandemic period. The significantly increased ICA positivity in the pandemic may support the effects of COVID-19 on autoimmune T1DM.