OBJECTIVE: Children are usually mildly affected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, COVID-19). However, the pandemic has caused collateral damage to those with non-COVID-19 diseases. We aimed to determine the impact of the COVID-19 pandemic on the presentation of newly diagnosed childhood onset type 1 diabetes. METHODS: This was a cross-sectional study conducted over a one-year period. We compared the severity of presentation of new-onset type 1 diabetes in children under the age of 18 presenting to the multi-centre North Central London diabetes network before (1st July 2019 to 22nd March 2020) and during (23rd March 2020 to 30th June 2020) the first wave of the COVID-19 pandemic in the United Kingdom. RESULTS: Over the one-year study period, a total of 30 children presented with new-onset type 1 diabetes during the pre-pandemic period and 17 presented during the first COVID-19 wave. Children presented more frequently in DKA during the first COVID-19 wave compared with pre-pandemic (pre-pandemic: mild 13%, moderate 6.7%, severe 10%; first COVID-19 wave: mild 5.9%, moderate 24%, severe 47%; p=0.002). During the first COVID-19 wave, DKA presentations in children with a family history of type 1 diabetes were fewer compared to those without a family history (33.3% vs 100.0%; p=0.006). Children presenting in severe DKA pre-pandemic were younger than those not in severe DKA (3.9 years vs 12.2 years, p<0.001) but this difference was not significant during the first COVID-19 wave (10.1 years vs 11.2 years, p=0.568). Presenting HbA1c measurement was higher in those presenting during the first COVID-19 wave (13.0±1.7 vs 10.4±3.2%; 119±19 vs 90±35mmol/mol; p=0.008). CONCLUSION: The COVID-19 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes. Whatever the context, young people with suspected new-onset type 1 diabetes should be referred for urgent clinical review.
The SARS-CoV-2 Pandemic Is Associated With Increased Severity Of Presentation Of Childhood Onset Type 1 Diabetes Mellitus: A Multicentre Study Of The First COVID-19 Wave