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. 2021 Sep:122:154842.
doi: 10.1016/j.metabol.2021.154842. Epub 2021 Jul 30.

Diabetic ketoacidosis in pediatric patients with type 1- and type 2 diabetes during the COVID-19 pandemic

Charlotte Loh  1 , Paul Weihe  1 , Nicole Kuplin  1 , Kerstin Placzek  1 , Susann Weihrauch-Blüher  2
Affiliations

Diabetic ketoacidosis in pediatric patients with type 1- and type 2 diabetes during the COVID-19 pandemic

Charlotte Loh et al. Metabolism. 2021 Sep.

Abstract

Background: COVID-19 pandemic caused families to stay home and cancel everyday activities. Hospital admissions decreased, affecting changes in diagnoses and management of chronic disease in children.

Aims: We analyzed how the first lockdown influenced clinical presentation and manifestation of children with diabetes mellitus (DM) in a German University Hospital.

Methods: During March 15th and October 11th 2020, data on general patient information, clinical symptoms and on lab results related to diabetic ketoacidosis (DKA) were analyzed in children (0-18 years) who presented with new onset of DM or poor metabolic control of known DM. All data including frequency and severity of DKA were compared to data from patients who presented in 2019.

Results: Data from 125 participants with DM were evaluated (2020: n = 52; 2019: n = 73). In 2020, twelve patients (23.1%) were diagnosed with new onset DM, two of them with type2 diabetes, and 66.7% presented with DKA including both patients T2DM. In 2019, 24.5% of patients had new onset DM, and 50% of them presented with DKA. In 2020, patients with new onset DM were younger, presented with more severe symptoms of DKA and had to stay longer in hospital compared to 2019. In 2020, six children (50%) with new onset DM were <6 years, whereas in 2019 most children with new onset DM were adolescents (n = 7, 38.9%).

Conclusion: COVID-19 lockdown aggravated complications of diabetes onset and therapy management, including severity and frequency of DKA. It underlines the need of health education for early DKA diagnosis to early identify children at risk.

Keywords: COVID-19; Children; Diabetes mellitus; Diabetic ketoacidosis; Lockdown.

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Conflict of interest statement

Declaration of competing interest The authors disclose any potential conflict of interest.

Figures

Fig. 1
Fig. 1
a: Distribution of age groups in patients with known DM who had to be hospitalized in 2020 compared to 2019. b: Distribution of age groups in patients with new onset DM in 2020 compared to 2019.
Fig. 2
Fig. 2
a: Frequency and severity of DKA: patients with new onset DM in 2020 compared to 2019. b: Severe DKA in patients with new onset DM: Distribution of age groups in 2020 compared to 2019.
Fig. 3
Fig. 3
Average difference and 95%-CI in 2020 compared to 2019 (ND = new onset DM; AD = already diagnosed DM; base excess in mmol/l; HbA1c in %; age = age at admittance to hospital).
See this image and copyright information in PMC

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