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

ABSTRACT

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.