Does the severity of diabetic ketoacidosis in children with type 1 diabetes change during the COVID-19 pandemic? A single-center experience from a pediatric intensive care unit

OBJECTIVE: During the COVID-19 pandemic, health-care services for diseases other than COVID-19 were interrupted, and patient referrals to health institutions were postponed due to their fear of being infected with COVID-19. Under this situation, we conducted this study to evaluate the clinical and laboratory findings of COVID-19 in patients with Type 1 Diabetes Mellitus (T1DM) hospitalized in our pediatric intensive care unit (PICU) with the diagnosis of diabetic ketoacidosis (DKA) during the pandemic period, and the impact of the pandemic on these findings.
METHODS: We retrospectively evaluated 55 children aged from 1 month to 18 years old, diagnosed with DKA, and followed up at Istanbul Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital PICU between April 2020 and December 2021.
RESULTS: A total of 55 patients with DKA as a complication of T1DM were admitted to the PICU during the COVID-19 pandemic. While there was no significant difference in pH and HCO3 values between those with newly diagnosed T1DM and those with previously-diagnosed T1DM, the HbA1c ratio of newly diagnosed DMs was significantly higher. Of the 55 patients, 4 were COVID-19 PCR positive, and two patients had COVID-19 antibody positivity. When COVID-19 positive patients were compared with negative patients, no significant difference was found between the hospital stay, glucose, HbA1c, lactate, pH, and HCO3 values.
CONCLUSION: Higher HbA1c levels of newly diagnosed patients presenting with DKA may be associated with delayed admission to the health institutions due to COVID-19 and the length of insulin-free periods compared to pre-diagnosed patients with T1DM. In conclusion, our results, emphasize the importance of physician’s and family’s awareness of the symptoms of diabetes in terms of early diagnosis and prevention of DKA during public health measures due to COVID-19.

Tip 1 diyabetli çocuklarda diyabetik ketoasidoz þiddeti COVID-19 pandemisi sýrasýnda deðiþiyor mu? Pediatrik Yoðun Bakým Ünitesinden tek merkez deneyimi

Amaç
COVID-19 pandemisi süresince COVID-19 dýþýndaki hastalýklara yönelik saðlýk hizmetleri kesintiye uðradý ve COVID-19'a yakalanma korkusu nedeniyle hastalarýn saðlýk kuruluþlarýna sevkleri ertelendi. Bu kapsamda, yazýmýzda pandemi döneminde diyabetik ketoasidoz (DKA) tanýsý ile çocuk yoðun bakým ünitemizde (ÇYBÜ) yatan T1DM'li hastalarýn klinik ve laboratuvar bulgularýný deðerlendirmek ve bu pandeminin bu bulgular üzerindeki etkisini dðerlendirmeyi amaçladýk.
Yöntemler
Nisan 2020 - Aralýk 2021 tarihleri arasýnda XXX Eðitim ve Araþtýrma Hastanesi ÇYBÜ'nde izlenen, yaþlarý 1 ay ile 18 arasýnda deðiþen DKA tanýsý almýþ 55 çocuðu retrospektif olarak deðerlendirdik.
Sonuçlar
COVID-19 pandemisi sýrasýnda ÇYBB'ye T1DM komplikasyonu olarak DKA'lý toplam 55 hasta kabul edildi. Yeni taný konmuþ T1DM'li ve bilinen T1DM'li olgular arasýnda pH ve HCO3 deðerlerinde anlamlý fark bulunmazken, yeni taný almýþ DM'lerin HbA1c oraný anlamlý olarak daha yüksekti. 55 hastanýn 4'ü COVID-19 PCR pozitifti ve 2 hastada COVID-19 antikor pozitifliði vardý. COVID-19 PCR pozitif hastalar ile negatif hastalar karþýlaþtýrýldýðýnda hastanede kalýþ süresi, glukoz, HbA1c, laktat, pH ve HCO3 deðerleri arasýnda anlamlý bir fark bulunmadý.
Çözüm
DKA ile baþvuran yeni tanýlý hastalarýn HbA1c düzeylerinin önceden T1DM tanýsý almýþ hastalara kýyasla yüksek olmasý, COVID-19 nedeniyle saðlýk kuruluþlarýna geç baþvuru ve insülinsiz dönemlerin uzunluðu ile iliþkili olabilir. Sonuç olarak, sonuçlarýmýz, COVID-19'a baðlý halk saðlýðý önlemleri sýrasýnda DKA'nýn erken teþhisi ve önlenmesi açýsýndan hekim ve ailenin diyabet semptomlarý hakkýnda farkýndalýðýnýn önemini vurgulamaktadýr. (NCI-2022-7-18/R1)