Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
J Clin Res Pediatr Endocrinol. 2023 Aug 23;15(3):264-267. doi: 10.4274/jcrpe.galenos.2023.2022-11-4. Epub 2023 Mar 29.
Diabetic ketoacidosis (DKA) is a life-threatening, acute complication of type 1 diabetes mellitus (T1DM). Infection is the most common precipitating factor for DKA, being responsible for more than 50% of such complications. The frequency and severity of DKA in children with T1DM, before and during the coronavirus disease 2019 outbreak were evaluated and compared with pre-pandemic presentation and severity rates.
In total, 199 patients younger than 18 years were included in the study. Patients were divided into two groups: the Coronavirus disease-2019 (COVID-19) pandemic group (new onset T1DM presenting from March 2020 to March 2021; the control group included new onset T1DM from March 2016 to March 2020.
The rate of DKA at presentation was similar (p=0.393) during the pandemic period (58.3%) compared to the pre-pandemic years (44.8-64.3%). Although the percentage of DKA was similar, the rate of severe DKA in the COVID-19 group was higher than previous years. Although not significant, the duration of diabetes symptoms was longer in the COVID-19 period than the previous years.
This study suggests that the rate of severe DKA, but not the overall rate of DKA, has increased during the COVID-19 pandemic compared to the prior four years. This may be due to the behavior of the parents of sick children and the limited access to the healthcare system. Despite this limited access, parental concern may have been sufficiently high to seek medical attention for their children, avoiding an increased frequency of DKA as the first presentation of new-onset T1DM.
糖尿病酮症酸中毒（DKA）是 1 型糖尿病（T1DM）的一种危及生命的急性并发症。感染是 DKA 的最常见诱发因素，超过 50%的此类并发症由其引起。评估并比较了 COVID-19 大流行前后儿童 T1DM 患者 DKA 的发生频率和严重程度，并与大流行前的表现和严重程度进行了比较。
本研究共纳入 199 名年龄小于 18 岁的患者。患者分为两组：COVID-19 大流行组（新发 T1DM 于 2020 年 3 月至 2021 年 3 月期间发病；对照组包括 2016 年 3 月至 2020 年 3 月期间新发的 T1DM）。
大流行期间（58.3%）与大流行前（44.8-64.3%）相比，新发 T1DM 患者就诊时 DKA 的发生率相似（p=0.393）。尽管 DKA 的比例相似，但 COVID-19 组重度 DKA 的发生率高于前几年。尽管无统计学意义，但 COVID-19 组糖尿病症状持续时间较前几年更长。
本研究表明，与前四年相比，COVID-19 大流行期间严重 DKA 的发生率增加，而非总体 DKA 发生率增加。这可能是由于患病儿童的父母的行为以及获得医疗保健系统的机会有限所致。尽管这种有限的途径，父母的关注可能已经足够高，为他们的孩子寻求医疗关注，避免了由于新发病例 T1DM 而导致的 DKA 频率增加。
