ABSTRACT
Background. There are numerous reports indicating increased risk of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes (T1D) in childhood during COVID-19 pandemic. Delayed diagnosis, reduced access to immediate health care and psychological effects of pandemic have been suggested as possible reasons. Method(s): We conducted cross sectional, single-center study at Department of Pediatrics, University Hospital Center Zagreb, Croatia, evaluating severity of DKA in patients diagnosed during COVID-19 pandemic as compared to pre-pandemic period. Besides COVID-19 pandemic, Croatia suffered two severe earthquakes, adding psychological burden and difficulties to health care organization. The data collected for the period March 2012 - March 2022 included: age, sex, laboratory parameters at presentation (pH, HCO3, HbA1c), association of celiac and autoimmune thyroid disease and frequency of positive pancreatic antibodies. The pandemic group (PG) included patients diagnosed form March 2020 to March 2022 while previously diagnosed patients comprised control group (CG). Result(s): There were 107 patients in pandemic group (57M/50F) as compared to 337 controls (191M/146F). No significant difference was found between PG and CG regarding age (9.2/ 8.9 years), sex, DKA frequency (44.9/40.4%) or severity (mild: 15.2/13.8%;moderate 15.2/13.5%;severe: 13.3/12.3%), HbA1c at diagnosis (11.5/ 11.2%) and frequency of admission to intensive care unit. There was no difference regarding frequency of celiac (5.6/ 3.0%) and autoimmune thyroid disease (15.0/22.0%) at presentation, or negative pancreatic antibodies (6.8%/4.5%). We found significantly higher frequency of new-onset diabetes in children < 5 years during pandemic (32.7% vs. 20.5%, p=0.009). Particularly increased frequency during pandemic was noted in children < 2 years (12.1% vs. 6.2%, p=0.045). The age distribution was as following in PG/CG: <2 yrs 12.1/6.2%, 2-5 yrs 20.6/14.2%, 5-11 yrs 26.2/41.8%, 11-18 yrs 41.1/37.7%. No difference in DKA frequency or severity between PG and CG was noted among age groups. When comparing 1st and 2nd pandemic year, there was no difference regarding age, sex, frequency and severity of DKA. Conclusion(s): Despite adversities experienced during COVID- 19 pandemic and post-earthquake recovery, we did not find increased frequency or severity of DKA in new-diagnosed T1D. However, we found increased percentage of new-onset T1D among patients <5 years during pandemic, particularly < 2 years, but we did not find increased DKA presentation in any age group. Further studies are necessary to elucidate the effect of COVID-19 pandemic on presentation and related complications of T1D and to determine if the shift toward the younger age at presentation will be abiding.