Increased Frequency of Diabetic Ketoacidosis: The Link With COVID-19 Pandemic

Giuseppe d'Annunzio; Marta Bassi; Elena Lucia De Rose; Marilea Lezzi; Nicola Minuto; Maria Grazia Calevo; Alberto Gaiero; Graziella Fichera; Riccardo Borea; Mohamad Maghnie

doi:10.3389/fcdhc.2022.846827

Increased Frequency of Diabetic Ketoacidosis: The Link With COVID-19 Pandemic

Front Clin Diabetes Healthc. 2022 Feb 24:3:846827. doi: 10.3389/fcdhc.2022.846827. eCollection 2022.

Authors

Giuseppe d'Annunzio¹, Marta Bassi^{1

2

3}, Elena Lucia De Rose^{1

2

3}, Marilea Lezzi¹, Nicola Minuto¹, Maria Grazia Calevo⁴, Alberto Gaiero⁵, Graziella Fichera⁵, Riccardo Borea⁶, Mohamad Maghnie^{1

2

3}

Affiliations

¹ Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
² Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.
³ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy.
⁴ Epidemiology and Biostatistics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.
⁵ Pediatric and Neonatology Unit, San Paolo Hospital, Savona, Italy.
⁶ Pediatric Unit, Sanremo Hospital, Sanremo, Italy.

Abstract

Aims: Diabetic ketoacidosis is the most severe metabolic derangement due to prolonged insulin deficiency as in type 1 diabetes. Diabetic ketoacidosis, a life-threatening condition, is often diagnosed late. A timely diagnosis is mandatory to prevent its consequences, mainly neurological. The COVID-19 pandemic and lockdown have reduced the availability of medical care and access to hospitals. The aim of our retrospective study was to compare the frequency of ketoacidosis at the diagnosis of type 1 diabetes between the lockdown-post lockdown period and the previous two calendar years, in order to evaluate the impact of the COVID-19 pandemic.

Patients and methods: We retrospectively assessed the clinical and metabolic data at the diagnosis of type 1 diabetes in children in the Liguria Region during 3 different time periods: calendar year 2018 (Period A), calendar year 2019 until February 23,2020 (Period B) and from February 24, 2020 onwards to March 31, 2021 (Period C).

Results: We analyzed 99 patients with newly-diagnosed T1DM from 01/01/2018 to 31/03/2021. Briefly, a younger age at diagnosis of T1DM was observed in Period 2 compared to Period 1 (p = 0.03). The frequency of DKA at clinical onset of T1DM was similar in Period A (32.3%) and Period B (37.5%), while it significantly increased in Period C (61.1%) compared to Period B (37.5%) (p = 0.03). PH values were similar in Period A (7.29 ± 0.14) and Period B (7.27 ± 0.17), while they were significantly lower in Period C (7.21 ± 0.17) compared to Period B (p = 0.04).

Conclusions: An increase in the frequency of diabetic ketoacidosis has been documented in newly diagnosed pediatric patients in the Liguria Region during and after the lockdown period compared to previous calendar years. This increase could have been caused by the delay in diagnosis following the restrictions imposed by the lockdown with consequently reduced access to health care facilities. More information on the risks of ketoacidosis is desirable by means of social and medical awareness campaigns.

Keywords: COVID-19; children; diabetic ketoacidosis; health care services; pandemic; type 1 diabetes mellitus.