Available online 1 December 2022

Author links open overlay panelAbstractIntroduction

ß-pancreatic cells are susceptible to SARS-CoV-2 infection and replication; this could lead to infection-related diabetes or precipitate the onset of type 1 diabetes. This study aimed to determine the severity at diagnosis, analyzing clinical and epidemiological features at debut in children under 16 years of age in the context of the SARS-CoV-2 pandemic.

Material and methods

A retrospective observational multicenter study was carried out in 7 hospitals of the public health network located in the south of our community. The severity at debut is compared with that of the two previous years (2018 and 2019). The level of statistical significance is set at p < 0.05.

Results

In 2020, 61 patients debuted at the 7 hospital centres. The mean age was 10.1 years (SD: 2.6), 50.8% older than 10 years. The clinical profile at diagnosis was ketoacidosis in 52.5% compared to 39.5% and 26.5% in the previous two years (p < 0.01). The mean pH (7.24 vs 7.30/7.30) and excess of bases (−11.9 vs −7.43/−7.9) was lower than in the previous two years, and the glycated haemoglobin higher (11.9 vs 11/10.6), p < 0.05. At least 10% of the patients had a positive history of SARS-CoV-2 infection.

Conclusions

There has been an increase in the frequency of diabetic ketoacidosis in type 1 diabetes onset during the first year of the COVID-19 pandemic.

ResumenIntroducción

Las células ß-pancreáticas son susceptibles a la infección y replicación de SARS-CoV-2, lo que podría conducir a una diabetes relacionada con infección o precipitar el debut de una diabetes tipo 1. El objetivo de este estudio ha sido determinar la gravedad al diagnóstico, analizando características clínicas y epidemiológicas en el contexto de la pandemia por SARS-CoV-2 en menores de 16 años.

Material y métodos

Se lleva a cabo un estudio multicéntrico observacional retrospectivo en7 hospitales de la red pública de sanidad ubicados en el sur de nuestra comunidad. Se compara la gravedad al debut con la de los dos años previos (2018 y 2019). Se fija el nivel de significación estadística en una p < 0,05.

Resultados

En 2020 61 pacientes debutaron en los 7 centros hospitalarios. La edad media fue 10.1 años (DE: 2.6), 50.8% mayores de 10 años. La forma clínica del debut fue cetoacidosis en el 52.5% frente al 39.5% y 26.5% en los dos años previos (p < 0.01). El pH medio (7.24 vs 7.30/7.30) y exceso de bases (−11.9 vs −7.43/−7.9) fue menor que en los dos años anteriores y la hemoglobina glicada mayor (11.9 vs 11/10.6), p < 0.05. Al menos el 10% de los pacientes tenían antecedentes positivos de infección por SARS-CoV-2.

Conclusiones

Durante el primer año de pandemia COVID-19 ha habido un aumento en la frecuencia de cetoacidosis diabética como forma de debut.

Introduction

Type 1 diabetes (T1DM) is an autoimmune disease involving different triggering factors: genetic, socioeconomic and environmental.1 Against the backdrop of the COVID-19 pandemic, several studies showing the susceptibility of pancreatic beta cells to SARS-CoV-2 infection and replication have been published,2 which could lead to infection-related diabetes according to the WHO classification or precipitate the onset of T1DM.3

Ketoacidosis is one of the most severe complications of T1DM that is especially prevalent in the paediatric population, particularly children under five years of age.4 Global incidence rates vary widely from country to country and range between 15% and 80% for newly-diagnosed T1DM.5 In Spain, data published to date show a frequency of 40% of newly-diagnosed patients under 15 years of age.6 In Germany and Italy7 an increased incidence of ketoacidosis in children and adolescents at the onset of T1DM has been reported.8 Some publications in Spain suggest the same findings.9 Some of the hypotheses proposed to explain this phenomenon are the relationship with the strict lockdown imposed in the first few months of the pandemic, the fear of the population going to medical centres, or the role the infection itself could have in acting as an accelerator or trigger.10, 11

This study aimed to determine the clinical severity of patients under 16 years of age at the onset of diabetes against the backdrop of the SARS-CoV-2 pandemic and to compare this with the two previous years as any possible relationship with COVID-19 infection.

Section snippetsMaterial and methods

A retrospective, observational, multicentre study was conducted to determine the clinical and epidemiological characteristics of patients <16 years of age with new-onset T1DM in 2020, coinciding with the COVID-19 pandemic. Severity at onset was compared with the two previous years (2018 and 2019). Seven public hospitals located in the south of the Community of Madrid took part: Hospital Universitario de Fuenlabrada, Hospital Universitario Severo Ochoa (Leganés), Hospital Universitario de

Results

In 2020, 61 patients were diagnosed with T1DM at the seven hospitals. Some 24.6% of the patients came from a single centre. The mean age was 10.1 years (SD: 2.6; IQR: 7.2–13.5). Regarding age group, 36.1% of patients were aged 0–4 years, 13.1% 5–9 years and 50.8% >10 years. In total, 54.1% of the study population were female. Overall, 75.4% were of Spanish origin, 11.5% from North Africa, 6.5% from Eastern Europe and one patient was from Latin America. Some 31.1% of cases occurred in the third

Discussion

2020 saw an increase in the severity of the onset of T1DM in children under 16 years of age (higher frequency of ketoacidosis, lower pH, lower base excess [BE] and higher glycated haemoglobin), as has been reported in other countries.13, 14 Although the association with lockdown and the fear of going to medical centres has been one of the hypotheses proposed to explain this8 the time since onset of symptoms was <2 weeks in slightly more than 50% of cases, with no differences compared to the

Conclusions

In 2020, 52.5% of patients had ketoacidosis at onset, representing an increase in this form of presentation and therefore an increase in severity.

Between 10% and 12.5% of patients had a positive history of SARS-CoV-2 infection.

A national registry of newly-diagnosed T1DM cases, their severity and their possible association with SARS-CoV-2 infection are just one of the measures that need to be implemented as part of the ketoacidosis prevention policies.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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