ESPE Abstracts

Objective: Children are usually mildly affected by Severe Acute Respiratory Syndrome Coronavirus 2 infection (SARS-CoV-2, COVID-19). However, the pandemic has impacted negatively on children 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 a multi-centre paediatric diabetes network before (1st July 2019 to 22nd March 2020) and during (23^rd March 2020 to 30^th June 2020) the first wave of the COVID-19 pandemic in the United Kingdom.

Results: A total of 47 children presented during the one-year study period: 30 pre-pandemic and 17 during the first COVID-19 wave.The odds ratio (OR) of presenting with any diabetic ketoacidosis (DKA) and with severe DKA was greater during the first COVID-19 wave compared to the pre-pandemic period (OR 7.58 [95% Confidence Interval (CI) 1.9-29.7], P = 0.003 and OR 8.0, [CI 1.7-36.8], P = 0.009, respectively). During the first COVID-19 wave, older children were less likely to present in severe DKA (OR 0.77 per year increase in age, [CI=0.6-0.9], P = 0.018). Children with a family history of type 1 diabetes were less likely to present in any DKA (P=0.002). HbA1c measurement at diagnosis was higher in children presenting during the first COVID-19 wave (12.9 vs 11.0%; 119±5 vs 96±5 mmol/mol, P=0.008).

Conclusion: The COVID-19 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes across multiple clinical and biochemical parameters. Young people with suspected new-onset type 1 diabetes should be referred for urgent clinical review. This is particularly true in view of the disruption to usual clinical care caused by the COVID-19 pandemic.