P-06: Increased DKA at type 1 diabetes onset during the COVID-19 pandemic without evidence of delayed diagnosis or worse glycemic outcomes
V R d A Borges, G Panuci, M M R do Valle, J A C de Oliveira, R S Berardo, C T da Fonseca, L A Cordeiro, C M Borschvier, S Esch, H M B L Berbara, B S PuglieseAbstract
Introduction
Emerging evidence suggests that the COVID-19 pandemic altered the epidemiology of type 1 diabetes mellitus (T1DM) with both increases in the number of new onset diagnoses and the incidence and severity of Diabetic Ketoacidosis (DKA) at presentation.
Objectives
To evaluate DKA incidence at T1DM onset and its association with demographic and clinical characteristics, comparing pandemic with pre- and post-pandemic periods.
Methods
Retrospective longitudinal study including 76 pediatric patients with newly diagnosed T1DM (2018–2025) at a tertiary center. Data included age, sex, BMI, and symptom duration. DKA was defined according to ISPAD criteria. Statistical analysis used chi-square, Mann–Whitney and odds ratios.
Results
Overall DKA incidence was 60.5% (46/76), with a mean age at diagnosis of 8.8 years, a male predominance of 60.5%, and a mean symptom duration of 24.5 days. Children under 5 years of age exhibited the highest DKA rates (86.6%) and a significantly greater risk of severe presentation (OR 4.9; p < 0.05). DKA incidence was markedly higher during the COVID-19 pandemic years compared to the post-pandemic period (73.3% vs. 44.4%; p = 0.018; OR 3.44, 95% CI 1.21–9.75). Mean age at diagnosis increased significantly over time (p < 0.05), while BMI remained stable. Symptom duration did not differ significantly between the pandemic and post-pandemic periods (20.7 ± 16.5 vs. 29.6 ± 26.2 days; p > 0.05). No statistical association was observed between the increased incidence of DKA and delayed diagnosis. One-year follow-up HbA1c levels were similar between the pandemic and post-pandemic cohorts (8.58 ± 1.1% vs. 8.60 ± 1.4%; p = 0.96).
Conclusions
The pandemic was associated with increased DKA at T1DM onset, not explained by delayed diagnosis or baseline patient characteristics. The subsequent decline may be related to older age at diagnosis. Glycemic control at 1 year remained unchanged. Early recognition of T1DM symptoms remains essential to prevent severe presentations during healthcare disruptions