Children in Germany who received a new diagnosis of type 1 diabetes during the coronavirus disease 2019 (COVID-19) pandemic are presenting with higher rates of diabetic ketoacidosis and severe diabetic ketoacidosis than observed in the previous 2 years, according to study findings published in JAMA.
This study was an analysis of data from the German Diabetes Prospective Follow-up Registry (DPV) and included 532 children and adolescents (median age, 9.9 years) with a newly diagnosed type 1 diabetes from March 13 through May 13, 2020, at 216 diabetes centers.
Investigators assessed the rate of diabetic ketoacidosis, defined by a pH level <7.3 and/or bicarbonate level <15 mmol/L. Severe diabetic ketoacidosis, defined as pH level <7.1 and/or bicarbonate level <5 mmol/L, was also assessed. Using multivariable logistic regression analyses, the researchers compared the rates of diabetic ketoacidosis and severe diabetic ketoacidosis during the COVID-19 period with the same period during 2018 and 2019.
Of the 532 children diagnosed with type 1 diabetes from March 13 through May 13, 2020, diabetic ketoacidosis was present in 44.7% (n=238). Severe diabetic ketoacidosis was observed in 19.4% (n=103) of patients. The frequency of diabetic ketoacidosis was higher during the studied COVID-19 period compared with the same period in 2019 (44.7% vs 24.5%, respectively; adjusted relative risk [aRR], 1.84; 95% CI, 1.54-2.21; P <.001) and 2018 (44.7% vs 24.1%; aRR, 1.85; 95% CI, 1.54-2.24; P <.001). Likewise, the incidence of severe diabetic ketoacidosis was higher during the COVID-19 era compared with 2019 (19.4% vs 13.9%, respectively; aRR, 1.37; 95% CI, 1.04-1.81; P =.03) and 2018 (19.4% vs 12.3%; aRR, 1.55; 95% CI, 1.15-2.10; P =.004).
The highest risk of diabetic ketoacidosis was observed in children aged <6 years in 2020 vs 2019 (51.9% vs 18.4%, respectively; aRR, 2.75; 95% CI, 1.88-4.02; P <.001) and in 2018 (51.9% vs 24.2%; aRR, 2.12; 95% CI, 1.48-3.02; P <.001). Children aged <6 years also had a significantly higher risk of severe diabetic ketoacidosis in 2020 vs 2019 (24.4% vs 12.2%, respectively; aRR, 1.90; 95% CI, 1.12-3.23; P =.02) and 2018 (24.4% vs 11.7%; aRR, 2.06; 95% CI, 1.16-3.65; P =.01).
Study limitations included the lack of individual data on patients’ socioeconomic statuses and family histories of diabetes.
Researchers suggested that additional study into the potential factors associated with the “increase in diabetic ketoacidosis during the COVID-19 pandemic and interventions to reduce diabetic ketoacidosis, such as public and health care clinician education or β-cell antibody screening, is required.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Kamrath C, Mönkemöller K, Biester T, et al. Ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the COVID-19 pandemic in Germany. JAMA. Published online July 20, 2020. doi: 10.1001/jama.2020.13445