Impact of COVID-19 in New-Onset Type 1 Diabetes Mellitus in a Large Portuguese Pediatric Diabetes Center

Introduction: Our aim was to characterize new-onset type 1 diabetes mellitus (T1D) cases in a pediatric population referred to a large pediatric diabetic center throughout the first year of the COVID-19 pandemic, comparing it to previous years. Methods: Retrospective study including patients under 18 years with new-onset T1D, from March 12th 2020 to March 11(th) 2021. A control group was defined using data on patients under 18 years with new-onset T1D referred to the same hospital in the 3 previous years (from March 2017 to March 2020). Data was analyzed using SPSS. A p value of 0.05 was used as threshold of significance. Results: Between March 12(th) 2020 and March 12(th) 2021, 44 patients were diagnosed with new-onset T1D. The control group included 96 patients, resulting in an incidence of 32 cases/year (37.5% rise). January 2021 was the month with the higher number of diagnosis, corresponding to the peak of novel SARS-CoV-2 infections. During the pandemic, new-onset T1D cases in children under 2 years-old doubled, when comparing to mean incidence in previous years. Median delay to diagnosis was not significantly different from previous years. Diabetic ketoacidosis (DKA) at presentation was present in 50% of cases that were diagnosed after lockdown, increasing substantially from previous years (38.5%). DKA's severity was also significantly higher (40.9%, p=0.04), as were Intensive Care Unit admission (13.6%, p=0.04). Conclusion: Despite the existance of molecular pathways that could lead to islet cell injury, the role of the new coronavirus in the pathogenesis of DKA and T1D onset is still unclear. Disease severity could also be related to a higher proportion of younger children.

Risk factors for diabetic ketoacidosis through eight years of new-onset type 1 diabetes mellitus in a large Portuguese pediatric diabetes center: A shift towards younger age

Introduction: The rate of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus (T1D) is multifactorial. There seems to be an inverse relationship between T1D's incidence and DKA's frequency. DKA has been reported to be more common among young children. Recently, the COVID-19 pandemic has posed additional challenges as to diagnosing T1D. Objectives: We aimed to assess the rate of DKA and associated risk factors in pediatric new-onset T1D in a large pediatric diabetes center in Portugal. Methods: Retrospective analysis of data of patients referred to a level III pediatric hospital between January 1st, 2013 and December 31th, 2020 (8 years). Results: We included 276 children and adolescents with a median age of 9,6 years, 20,1% under 5 years old. A mean incidence of 35 new cases/year was observed, with an upward trend. Newonset T1D cases under 5 years old raised progressively, having more than tripled throughout the study period (n=3 in 2013 vs. n=10 in 2020). In total, 38% children and adolescents presented with DKA, ranging from 23,3% in 2013 to 43,2% in 2020, while remaining stable (37,2%-40,9%) in the period in-between. Overall, DKA was considered severe in 24,8% of cases, ranging from 6% in 2017 to 47% in 2020. 20 (7,2%) patients were admitted to the intensive care unit. DKA at presentation was more frequent in the age group under 2 years old (p=0,016), in which 80% of patients presented with DKA. Non-DKA presentation was associated with family history of T1D (p=0,005). Conclusions: Our study shows an upward trend in T1D's incidence in children under 5 years old and a high DKA rate at disease onset, which was more frequent in patients under 2 years of age. In the first year of COVID-19 pandemic, 43% of DKA was considered severe. It is urgent to implement educational programs to promote earlier diagnosis. Broader studies are required to provide a representative national landscape of the epidemiology of T1D in pediatric population in Portugal.

COVID-19 and new-onset type 1 diabetes mellitus in a large Portuguese pediatric diabetes center: What changed?

Introduction: On 12th March 2020, a national lockdown was imposed in Portugal, as a response to rising COVID-19 cases. Since then healthcare access patterns were deeply modified. Objectives: In this study, we tried to understand what shifted from prior years in new-onset type 1 diabetes mellitus (T1D). Methods: It was performed a retrospective analysis of patients referred to a level III pediatric hospital from March 2020 until March 2021. Patients admitted during the same period in the 3 previous years were set as control group. Results: Since lockdown imposition, 44 children and adolescents were diagnosed T1D, contrasting with prior mean incidence of 32 cases/ year. Median age was 9,9 years (min. 0,5 - max. 15,8). Children under 2 years-old represented 4,9% of cases, contrasting with only 2,1% in previous years. All subjects were tested for SARS CoV-2 but only 2 were positive. When comparing to prior years, subjects presenting with less than one week of symptoms almost doubled in 2020, (19,5% vs. 10,4%), and a higher rate of diabetic ketoacidosis (DKA) was also observed (53,7%, vs. 38,5%). DKA severity was also higher (40,9% vs. 21,6%;p=0,02 and 14,6% subjects required admission to intensive care unit. Conclusions: Similarly to other reports, a higher number of new-onset T1D was observed, with a comparable increase in severity. In contrast to what might have been expected, DKA prevalence and severity was not necessarily linked to delayed diagnosis. We estimate that such severity may be related to a higher proportion of younger patients. While the role of SARS CoV-2 exposure in pancreatic islet cells destruction is still under investigation, antibody assessment and detailed contact history could help to explain the increased prevalence and severity of new-onset T1D during the pandemic period.