A significantly higher proportion of children are presenting to diabetes centers with severe diabetic ketoacidosis (DKA) now compared with 2019, suggesting that the coronavirus disease 2019 (COVID-19) pandemic is hindering the appropriate care of chsildren with type 1 diabetes (T1D), according to a study in Diabetes Care.

The study was a cross-sectional survey of 68 Italian pediatric diabetes centers, all of which were asked to review medical records of patients <15 years of age who presented with new-onset or established T1D between February 20, 2020, and April 14, 2020. Centers were then asked to review the same information during the same time period in 2019. The number of patients with T1D, DKA, and COVID-19 were also reviewed and reported in this survey. The severity of DKA was also assessed.

During the 2020 timeframe, a total of 160 children between the ages of 0 and 14 years were diagnosed with T1D at the participating centers. This number was approximately 23% lower than that reported in these same centers in 2019 (n=208). The proportion of patients who presented with severe DKA was significantly higher in the 2020 timeframe compared with the same time in 2019 (44.3% vs 36.0%, respectively; P =.03). Overall, there was an 8.2% increase in severe DKA cases at these centers in 2020 compared with 2019.

Eight children (age range, 6-16 years) were diagnosed with COVID-19 during the observation period, with severe acute respiratory syndrome coronavirus 2 infection confirmed by polymerase chain reaction from nasopharyngeal samples.


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A limitation of the study was the assessment of only 2 consecutive years, suggesting the findings could be a result of random variation.

The study investigators indicate a significant number of children have received delayed diagnoses of diabetes because of the fear surrounding COVID-19 exposure. The investigators wrote that “specific strategies are essential to educate and reassure parents about timely attendance at the emergency department for children with symptoms that are not related to COVID-19” in an effort to reduce the incidence of severe DKA.

Reference

Rabbone I, Schiaffini R, Cherubini V, et al. Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children? Diabetes Care. Published online August 10, 2020. doi:10.2337/dc20-1321