Diabetic Ketoacidosis at Emergency Department Presentation during the First Three Months of the SARS-CoV-2 Pandemic: A Multicenter Cross-Sectional Study

Introduction: We examined Diabetic Ketoacidosis (DKA) at Emergency Department (ED) presentation in children with established and newly-diagnosed Type 1 Diabetes (T1D) during the first 3 months of the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) outbreak in Israel.

Methods: A retrospective cross-sectional study of 11 pediatric EDs was conducted. Children with T1D who attended the ED between 01/03/2020 and 31/05/2020 were compared with those who attended the ED between 01/03/2019 and 31/05/2019. The following variables were abstracted: age, sex, type of T1D (newly-diagnosed, established), presence of DKA, period of admission (pandemic, pre-pandemic), serum pH and bicarbonate levels on admission, and Intensive Care Unit (ICU) admission.

Results: Overall, 48,176 and 77,477 patients visited the EDs during the study periods in 2020 and 2019, respectively. 150 T1D patients with a median age (interquartile range, IQR) of 12.0 (8.7-14.1) years, and 154 T1D patients with a median (IQR) age of 12.0 (8.7-15.0) years attended the EDs during the 2020 and 2019 study periods, respectively. Among patients with established T1D, the rate of DKA significantly increased in the pandemic period compared to the pre-pandemic period (38/64 (59.3%) vs 31/74 (41.9%), p=0.043). There was an increasing, but not statistically significant, trend toward a higher rate of DKA in patients with newly-diagnosed T1D (46/86 (53.4%) vs 31/80 (38.7%), p=0.063).

Conclusions: Study findings provide evidence for the increased rates of DKA in children with T1D during the beginning of the outbreak.