P-01: Temporal trends and the impact of the COVID-19 pandemic on the clinical presentation of type 1 diabetes in children: a 2018–2024 cohort
G Augusto Vassoler Panuci, V Ribas de Abreu Borges, J Anne Oliveira Chagas Machado, M Martinez Ribeiro do Valle, C Teixeira da Fonseca, L Aguiar Cordeiro, C Medeiros Borschvier, S Esch, H Martins Benvenuto Louro Berbara, B Santiago Pugliese, R Szundy BerardoAbstract
Introduction
T1D incidence is rising, with presentation changes post-COVID-19. DKA at diagnosis remains a major concern. Longitudinal data on temporal trends and seasonality in middle-income pediatric populations are limited.
Objectives
To analyze temporal trends, clinical characteristics, DKA frequency, and seasonality in children with T1D (2018–2025).
Methods
Retrospective cohort of 76 children diagnosed with T1D at a tertiary center. Data included age, sex, BMI, DKA, and diagnosis date, stratified by pre-pandemic, pandemic, and post-pandemic periods.
Results
Incidence increased by 200% during the pandemic (15.0 cases/yr) vs. pre-pandemic baseline (5.0 cases/yr), remaining 80% higher post-pandemic (9.0 cases/yr). Mean age was 8.8 years, 60.5% male. Overall DKA frequency was 60.5%. DKA rates were significantly higher during the pandemic (73.3%) vs. post-pandemic (44.4%; p=0.018; OR 3.44). Children <5 years had the highest severe presentation risk (OR 4.9; p<0.05). Symptom latency did not differ between periods (p>0.05). A seasonal peak occurred in Q3 (July-September; 29.8% of cases). Mean 1-year HbA1c was similar between pandemic and post-pandemic cohorts (8.58% vs 8.60%; p=0.96). Recent follow-up showed an overall mean HbA1c of 8.8%, with 25% of patients at the <7.0% target.
Conclusions
A structural shift in T1D incidence occurred, with a 200% pandemic surge not yet returning to baseline. The pandemic significantly increased severe DKA risk (OR 3.44), independent of symptom latency. Children <5 years remain the most vulnerable. Despite acute initial severity, long-term glycemic control was not negatively impacted by the pandemic, though low target achievement (25%) highlights the urgent need for improved chronic management and early symptom recognition.