Type 1 Diabetes in Children in Times of COVID-19 Pandemic

Background: New onset Type 1 Diabetes (DM1) is a common diagnosis in Pediatrics.

Timely diagnosis decreases severe forms of presentation, such as diabetic ketoacidosis (DKA).

Objective: To evaluate whether the diagnosis of DM1 and its acute complications changed during the early phase of the Coronavirus Disease 2019 (COVID 19) pandemic in a level 2 Portuguese Hospital.

Methods: Retrospective study based on medical records of children admitted to the Emergency room (ER) in the first half of 2020 and same period of previous 5 years, with the inaugural diagnosis of DM1.

Results: 13 new cases of DM1 were registered between January and June 2020, 8 more cases than same period of 2019. The incidence was higher in boys (61.5%) and the median age was 12 years (minimum: 15 months; maximum:17 years).

Most cases occurred in May (38.5%).

Presenting symptoms were: polydipsia (13), polyuria (11), weight loss (9), polyphagia (5), nocturia (3) and altered state of consciousness (3).
Out of 13 cases recorded, 53.8% presented with DKA, and of these, 42.8% severe DKA (pH <7.1). It was necessary transfer 3 patients to the pediatric intensive care unit.
Of all patients, 9 underwent PCR SARS CoV2 research, all negative; worth referencing a patient that was positive for IgG SARS-CoV 2 antibody.
Observing the last 5 years, in the same period, the total number of new diagnoses was lower than in 2020 (median of 5/halfyear) and presentations were less severe (median of 1 DKA/halfyear).

Conclusion: The emergence of COVID-19 pandemic had an important impact on families’ behaviour (less trips to ER) that might be associated with higher incidence of DKA at diagnosis.

Furthermore, the SARS-CoV2 infection itself may act as a trigger responsible for more cases of DM1 compared to the last 5 years.