ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2021) 18 15.4 | DOI: 10.1530/ey.18.15.4

ESPEYB18 15. Editors’ Choice (1) (16 abstracts)

15.4. Ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the COVID-19 pandemic in Germany

Clemens Kamrath , Kirsten Mönkemöller , Torben Biester , Tilman R Rohrer , Katharina Warncke , Johanna Hammersen & Reinhard W Holl

JAMA. 2020;324(8):801–804.

The authors analysed data from the German Diabetes Prospective Follow-up Registry (DPV) of children and adolescents with Type 1 diabetes (T1D) between March 13 to May 13, 2020, when most kindergartens and schools in Germany were closed due to COVID-19 restrictions. Compared to the previous 2 years, the risk of diabetic ketoacidosis (DKA) at T1D onset was nearly double during COVID-19 lockdown (adjusted relative risk: 1.84; 95% CI, 1.54-2.21) and the increased risk was highest in young children age < 6 years (2.75; 95% CI, 1.88-4.02).

These are very robust data, collected from 216 of 217 eligible diabetes centers and involving 532 children and adolescents (median age 9.9 years) with newly diagnosed T1D during the COVID-19 lockdown period. DKA was present in 238 patients (44.7%) and severe DKA in 103 patients (19.4%), which is higher than in the previous 2 years (24.5% and 13.9%, respectively, in 2019). Children < 6 years had the highest rates of DKA (51.9%) and severe DKA (24.4%) during COVID-19 lockdown, and much higher than in 2019 (18.4% and 12.2%, respectively).

The authors discuss that the underlying reasons are likely to be multifactorial, including reduced access to medical services, fear of COVID-19 exposure, and other psychosocial factors. These same factors have also likely affected patients with diverse other acute and chronic health conditions across all Paediatric specialties and beyond. Few of those other clinics have such good systems for data collection and analysis as the DPV. So our ongoing challenge is to identify those services and families that have been adversely affected by the wide repercussions of COVID-19 and implement remedial actions.

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