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Children Presenting with Diabetes and Diabetic Ketoacidosis to Emergency Departments During the COVID-19 Pandemic in the UK and Ireland: An International Retrospective Observational Study
21 Pages Posted: 10 Aug 2022
More...Abstract
Background: The COVID-19 pandemic resulted in a dramatic decline in paediatric emergency department (ED) attendances. However, early observations highlighted an increase in both the number of children presenting with new onset diabetes and increase in the incidence and severity of diabetic ketoacidosis (DKA). We aimed to evaluate the characteristics of children presenting with new onset or decompensation of their existing diabetes to ED before and during the COVID-19 pandemic.
Methods: The DIMPLES study, (Diabetes Mellitus in children and young people presenting to the Emergency Department during the SARS-CoV-2 pandemic) is a retrospective multicentre study conducted across 49 UK and Irish sites. We compared the characteristics of children aged six months - 16 years presenting to ED with new onset diabetes or pre-existing diabetes with DKA during the COVID-19 pandemic (1st March 2020 – 28th February 2021) and the preceding year (1st March 2019 – 28th February 2020).
Findings: There were increases in new onset diabetes (1,015 to 1,183;17%), children presenting with DKA (395 to 566; 43%), severe DKA (141 to 252; 79%), and admissions to intensive care (38 to 72;89%). Diagnostic intervals for children presenting with new onset diabetes and DKA were similar across both years and delay did not appear to be the sole contributing factor to DKA in the pandemic.16/1028 children tested positive for SARS-CoV-2 on nasopharyngeal swabs; 13/16 presented with DKA, eight other children had serum COVID-19 antibodies. There was a 31·9% decrease in children with pre-existing diabetes presenting with DKA to ED in the pandemic year.
Interpretation: Our results show an increase in incidence and severity of presentation in children with new onset diabetes, with a decrease in children with a decompensation of their existing diabetes presenting to the ED.
Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of Interests: None.
Ethics Approval Statement: Ethics approval National research ethics committee approval was not necessary for this study based on the results from the Health Research Association decisions tool. The study was, however, registered with, and approved by, research governance offices at the respective sites. HRA approval was obtained in Ireland.
Keywords: COVID, Diabetes, Paediatrics, Emergency Medicine
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