ESPE Abstracts

Background: Paediatric diabetes has been the focus of attention during the COVID-19 pandemic. There are reports of increased incidence of new-onset type 1 paediatric diabetes and concerns about delayed presentations to the Emergency Department (ED) due to parental fears of SARS-CoV-2, resulting in an increase in the incidence and severity of DKA in children with new-onset diabetes.

Objectives: To characterise the features of children diagnosed with new onset type 1 diabetes in the COVID -19 pandemic exploring the incidence of diabetic ketoacidosis (DKA) and investigating any association with SARS-CoV-2.

Methods: We analysed data of new onset type 1 diabetes in children aged 6 months-17 years presenting from January to July 2020 to 12 paediatric diabetes units (PDUs) in the UK (178 children). Data from the same time period in 2019 (150 children) was compiled for comparison.

Results: There was a significant increase in the number of children with new-onset type 1 diabetes presenting with DKA in 2020 compared to 2019 (79vs49, P <0.05). There was also an increase in the number of children presenting in severe DKA in 2020 when compared to 2019 (36vs16). The incidence of new onset type 1 diabetes from January to July 2020 was similar to the previous 4 years. An apparent increase in 2020 was noted in two units, both from inner city localities with a highly diverse ethnic mix. 11 children were tested for COVID -19 serology and all were negative. Two children tested positive for COVID -19NS-RT-PCR and presented with severe DKA. In 2019 35% of children had symptoms of less than 2 weeks (of which 43% were in DKA), 46% of children in 2020 presented with symptoms less than 2 weeks (of which 47% were in DKA). The short period of type 1 diabetes symptoms before presenting in DKA in 2020 does not suggest a delay in diagnosis. The short period of symptoms of type 1 diabetes at presentation during the study period and the severity of DKA raises the possibility that infection with SARS–CoV–2 may have been a trigger resulting in loss of β-cells contributing to the rise in incidence and severity of DKA also accelerating the development of diabetes.

Conclusions: Our study did not provide evidence that the COVID-19 pandemic is leading to a marked increase in incidence of paediatric type 1 diabetes. However, there was increased incidence and severity of DKA during the study period in 2020.