Endocrine Abstracts

Background: Reports from several countries have suggested an increased incidence of diabetic ketoacidosis (DKA) at presentation of type 1 diabetes mellitus (T1DM) during the COVID-19 pandemic. Published data on this from the United Kingdom is sparse. We examined the frequency and severity of DKA at diagnosis of T1DM in children presenting to a university hospital during the first year of the pandemic in comparison to preceding years.

Methods: In England, the first COVID-19 national lockdown began on 23/03/2020. The first year of the pandemic was defined as 23/03/2020 to 22/03/2021. Data was compared to the four preceding years, each starting on 23^rd March. All children (<18 years) presenting to University Hospital Southampton NHS Foundation Trust with a new diagnosis of T1DM were included. Children transferred into the regional Paediatric Intensive Care Unit from other hospitals for escalation of care were excluded. Data was extracted from electronic case records, including presence and severity of DKA (defined using the British Society for Paediatric Endocrinology and Diabetes 2020 guideline), HbA1c, weight and height. Weight and body mass index (BMI) standard deviation scores (SDS) for age and sex were calculated using British 1990 reference data.

Results: During the first year of the pandemic, 30 children presented with T1DM, which was similar to the preceding 4 years (n=19-28 per year). 53.3% presented with DKA during the pandemic; however this proportion had increased each year since 2017/8: 32.1% in 2016/17, 17.9% in 2017/8, 39.1% in 2018/19, 42.1% in 2019/20 (p trend 0.022). There was a similar increasing trend for severe DKA (pH<7.1 or bicarbonate <5 mmol/l): 10.7%, 10.7%, 13.0%, 15.8%, 33.3% for each consecutive year from 2016/17 to 2020/21 (p trend 0.020). Age, sex, HbA1c, weight SDS and BMI SDS did not differ by year of presentation.

Conclusion: DKA was present in over half of children presenting with T1DM during the COVID-19 pandemic. There appears to be an upward trend in the frequency and severity of DKA at T1DM diagnosis, which predated, but continued to increase, during the COVID-19 pandemic. A novel education strategy to facilitate T1DM diagnosis before DKA might be beneficial in reversing this trend.