Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 26;11(15):4338.
doi: 10.3390/jcm11154338.

Increased Presentation of Diabetic Ketoacidosis and Changes in Age and Month of Type 1 Diabetes at Onset during the COVID-19 Pandemic in Spain

Isabel Leiva-Gea  1   2 , Cristina Antúnez Fernández  3 , Roque Cardona-Hernandez  4 , Marta Ferrer Lozano  5 , Pilar Bahíllo-Curieses  6 , Javier Arroyo-Díez  7 , María Clemente León  8   9 , Maria Martín-Frías  10 , Santiago Conde Barreiro  11 , Andrés Mingorance Delgado  12 , Jacobo Pérez Sánchez  13 ; Diabetes Group of the Spanish Pediatric Endocrinology Society (SEEP)
Affiliations

Increased Presentation of Diabetic Ketoacidosis and Changes in Age and Month of Type 1 Diabetes at Onset during the COVID-19 Pandemic in Spain

Isabel Leiva-Gea et al. J Clin Med. .

Abstract

Objective: To assess the impact of the COVID-19 pandemic and lockdown measures on the presenting characteristics (age at diagnosis, severity, monthly distribution) of newly diagnosed type 1 diabetes in Spanish children. Research Design and Methods: An ambispective observational multicenter study was conducted in nine Spanish tertiary-level hospitals between January 2015 and March 2021. Inclusion criteria: new cases of type 1 diabetes in children (0-14 years) recording age, sex, date of diagnosis, presence of diabetic ketoacidosis (DKA) at onset, and severity of DKA. Data were compared before and during the pandemic. Results: We registered 1444 new cases of type 1 diabetes in children: 1085 in the pre-pandemic period (2015-2019) and 359 during the pandemic (2020-March 2021). There was a significant increase in the group aged ≤4 years in the pandemic period (chi-squared = 10.986, df 2, p = 0.0041). In 2020-2021, cases of DKA increased significantly by 12% (95% CI: 7.2-20.4%), with a higher percentage of moderate and severe DKA, although this increase was not significant. In 2020, there was a sharp decrease in the number of cases in March, with a progressive increase from May through November, higher than in the same months of the period 2015-2019, highlighting the increase in the number of cases in June, September, and November. The first three months of 2021 showed a different trend to that observed both in the years 2015-2019 and in 2020, with a marked increase in the number of cases. Conclusions: A change in monthly distribution was described, with an increase in DKA at onset of type 1 diabetes. No differences were found in severity, although there were differences in the age distribution, with an increase in the number of cases in children under 4 years of age.

Keywords: COVID-19; DKA; diabetes onset; type 1 diabetes.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Percentage of DKA as a form of presentation during time periods 2015–2019 versus 2020–2021. Episodes are expressed in number and percentage (%).
Figure 2
Figure 2
Proportion of cases by DKA severity during periods 2015–2019 and 2020–2021. Each square represents DKA severity cases. Squares filled with vertical black bars represent mild cases; Squares with black dots represent moderate cases. Squares filled with horizontal black bars represent severe cases.
Figure 3
Figure 3
Monthly distribution of newly diagnosed type 1 diabetes cases by periods. Black line represents the cases by month for the period 2015–2019. Dotted line represents the cases by month during the year 2020. Dashed line represents the cases during the months of January, February, and March 2021.
See this image and copyright information in PMC

References

    1. Barreiro S.C., Rodríguez M.R., Lozano G.B., Siguero J.L., Pelegrín B.G., Val M.R., Dea M.L. Epidemiología de la diabetes mellitus tipo 1 en menores de 15 años en España. An. Pediatr. 2014;81:189.e1–189.e12. - PubMed
    1. Nóvoa Medina Y. Evolución de la incidencia de la diabetes mellitus tipo 1 en edad pediátrica en España. Endocrinol. Diabetes Nutr. 2018;65:65–67. doi: 10.1016/j.endinu.2017.11.010. - DOI - PubMed
    1. Spiteri G., Fielding J., Diercke M., Campese C., Enouf V., Gaymard A., Bella A., Sognamiglio P., Moros M.J.S., Riutort A.N., et al. First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020. Eurosurveillance. 2020;25:2000178. doi: 10.2807/1560-7917.ES.2020.25.9.2000178. - DOI - PMC - PubMed
    1. Khunti K., Del Prato S., Mathieu C., Kahn S.E., Gabbay R.A., Buse J.B. COVID-19, Hyperglycemia, and New-Onset Diabetes. Diabetes Care. 2021;44:2645–2655. doi: 10.2337/dc21-1318. - DOI - PMC - PubMed
    1. Boddu S.K., Aurangabadkar G., Kuchay M.S. New onset diabetes, type 1 diabetes and COVID-19. Diabetes Metab. Syndr. Clin. Res. Rev. 2020;14:2211–2217. doi: 10.1016/j.dsx.2020.11.012. - DOI - PMC - PubMed