DKA and new-onset type 1 diabetes in Brazilian children and adolescents during the COVID-19 pandemic

Abstract

We assess the severity and frequency of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus (T1D) patients and in patients with previous diagnosis of T1D in a referral Brazilian university hospital in the first five months of the COVID-19 pandemic. We also compare the data with data from pre-pandemic periods. Forty-three new-onset T1D patients were diagnosed between April and August of the years 2017, 2018, 2019, and 2020. During the COVID-19 pandemic, the number of newonset T1D was over twice the number of new-onset T1D in the same period in the three previous years. All the 43 patients survived and are now on outpatient follow-up. We also compared the characteristics of the T1D patients hospitalized between April and August of the years 2017, 2018, and 2019 (32 hospitalizations) to the characteristics of the T1D patients hospitalized between April and August/2020 (35 hospitalizations; 1 patient was hospitalized twice in this period). Fourteen of the 34 patients admitted during the pandemic presented with COVID-19-related symptoms (any respiratory symptom, fever, nausea, vomiting, and diarrhea), but only one had positive SARS-CoV-2 RT-PCR test. Samples from 32 out of these 34 patients were assayed for SARS-CoV-2 antibodies, and four patients were positive for total antibodies (IgM and IgG). In agreement with recent reports from European countries, we observed increased frequency of DKA and severe DKA in new-onset and previously diagnosed T1D children and adolescents in a large referral public hospital in Brazil in the first five months of the COVID-19 pandemic. The reasons for this outcome might have been fear of SARS-CoV-2 infection in emergency settings, the more limited availability of primary healthcare, and the lack of school personnel's attention toward children's general well-being.

Debuts de diabetes mellitus tipo 1 en niños antes, durante y después de la pandemia de COVID-19. Estudio multicéntrico

“…Asimismo, un estudio realizado en Alberta, Canadá, informó que la prevalencia de DM1 se mantuvo relativamente estable durante la pandemia de COVID-19 comparada con la prepandemia 19 . Por el contrario, un estudio desarrollado durante la pan-demia en Brasil enontró que las tasas de debuts de DM1 fueron más del doble que las tasas de debuts observados en los 3 años previos 20 . Además, estos estudios describieron un fuerte aumento en los debuts de DM1 en niños que residían en regiones muy afectadas por la pandemia de COVID-19 3,4 .…”

The Effect of the SARS-CoV-2 Pandemic on Presentation with Diabetic Ketoacidosis in Children with New Onset Type 1 Diabetes Mellitus

“…The incidence of T1DM in children from Lower Silesia during the COVID-19 pandemic was compared with previous years, and their clinical status (incidence of DKA, the mean pH upon at admission) at the time of diagnosis was worse during the pandemic than prior to it. A study from Southeastern Brazil revealed a higher incidence and severity of new onset T1DM cases with DKA during the pandemic period ( 20 ). Lawrence et al ( 21 ) compared new onset pediatric T1DM patients during the pandemic to those presenting in the previous 5 years and showed an increased incidence of severe DKA during pandemic period.…”

Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review

“…Data about the prevalence of diabetic ketoacidosis (DKA) are much more concordant in the literature. Several cohort studies [ 91 , 93 , 98 , 102 , 106 , 123 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 ] and two meta-analyses [ 114 , 164 ] report increases in DKA frequency and DKA severity at diagnosis among newly diagnosed T1D patients. A multicenter study, involving 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, the USA (Colorado), and Wales) compared the observed DKA prevalence in children and adolescents in 2020 and 2021 to predictions based on trends over the prepandemic years 2006–2019.…”