Objective: Diabetic ketoacidosis (DKA) - a potentially preventable complication of Type 1 diabetes (T1D) - is one of the most common chronic childhood diseases, and is associated with a significant risk of morbidity and mortality. The limited use of healthcare services due to fear of COVID-19 transmission during the pandemic has raised concerns of delays in T1D diagnosis, among other diseases. This study investigates the presenting characteristics of newly diagnosed T1D patients assessed in our clinic during the pandemic and compares them with the pre-pandemic period. Materials and Method: For the purpose of this study, the first year of the pandemic is referred to as the "pandemic period", and the previous three years as the "pre-pandemic period". Patient files were reviewed retrospectively, the demographic and clinical characteristics and laboratory findings of the patients were recorded, and the findings from both periods were compared. Results: The number of patients diagnosed with T1D was 44 in the pandemic period, and 39 in 2017, 22 in 2018 and 18 in 2019 in the pre-pandemic period. The two groups were noted to have similar age, sex, pubertal stage and anthropometric characteristics (p > 0.05). Regarding the type of presentation, the frequency of DKA was significantly higher in the pandemic period (68.2%) than in the pre-pandemic period (40.5%) (p = 0.006), and this difference was also observed in the comparison by years (p = 0.016). The duration of symptoms (16.5±10.7 vs. 23.5±17.6 days) and the length of hospital stay (10±3.9 vs. 15.2±5.5 days) were significantly shorter in the pandemic period (p = 0.032, and p < 0.001, respectively). There was no difference in the frequency of severe DKA between the pandemic (46.7%) and the pre-pandemic (37.5%) periods (p > 0.05). However, pH (7.17±0.16 vs. 7.26±0.14) and bicarbonate (12.8±6.3 vs. 16.6±6.3) levels were significantly lower in the pandemic period (p < 0.005). Additional signs of infection on admission were less frequent in the pandemic period (9.1%) than in the pre-pandemic period (27.8%) (p = 0.027). The groups did not differ in terms of HbA1c, C-peptide, concurrent thyroid autoantibodies and tissue transglutaminase antibodies (p > 0.05). The rate of anti-GAD positivity was higher in the pandemic period (73.8% vs. 39.2%) (p = 0.001) while the frequency of other diabetes-associated autoantibodies was similar between the groups (p > 0.05). The PCR test for COVID-19 was negative in six patients with a history of contact. Conclusion: We observed an increased frequency and severity of DKA in children with newly diagnosed T1D in the pandemic period, and our findings justify our concerns related to the diagnosis of other diseases during the pandemic. Studies to raise awareness of diabetes symptoms during the pandemic should be continued regularly to reach all segments of society. Our study provides an additional contribution to the literature in its coverage of the one-year period during the pandemic and its comparison with the previous three years.
A Long-Term Comparison of Presenting Characteristics of Children with Newly Diagnosed Type 1 Diabetes Before and During the COVID-19 Pandemic