The SARS-CoV-2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi-centre study of the first COVID-19 wave.

ABSTRACT

OBJECTIVE: Children are usually mildly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19). However, the pandemic has caused collateral damage to those with non-COVID-19 diseases. We aimed to determine the impact of the COVID-19 pandemic on the presentation of newly diagnosed childhood onset type 1 diabetes. METHODS: This was a cross-sectional study conducted over a 1-year period. We compared the severity of presentation of new-onset type 1 diabetes in children under the age of 18 presenting to the multi-centre North Central London diabetes network before (1 July 2019 to 22 March 2020) and during (23 March 2020 to 30 June 2020) the first wave of the COVID-19 pandemic in the United Kingdom. RESULTS: Over the 1-year study period, a total of 30 children presented with new-onset type 1 diabetes during the pre-pandemic period and 17 presented during the first COVID-19 wave. Children presented more frequently in diabetic ketoacidosis (DKA) during the first COVID-19 wave compared with pre-pandemic (pre-pandemic mild 13%, moderate 6.7%, severe 10%; first COVID-19 wave mild 5.9%, moderate 24%, severe 47%; p = 0.002). During the first COVID-19 wave, DKA presentations in children with a family history of type 1 diabetes were fewer compared to those without a family history (33.3% vs. 100.0%; p = 0.006). Children presenting in severe DKA pre-pandemic were younger than those not in severe DKA (3.9 years vs. 12.2 years, p < 0.001) but this difference was not significant during the first COVID-19 wave (10.1 years vs. 11.2 years, p = 0.568). Presenting HbA1c measurement was higher in those presenting during the first COVID-19 wave (13.0 ± 1.7 vs. 10.4 ± 3.2%; 119 ± 19 vs. 90 ± 35 mmol/mol; p = 0.008). CONCLUSION: The COVID-19 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes. Whatever the context, young people with suspected new-onset type 1 diabetes should be referred for urgent clinical review.