ESPE Abstracts

Introduction: The COVID-19 pandemic adversely impacted general access to healthcare. An association between SARS-CoV-2 infection and new-onset type 1 Diabetes (T1D), a more severe disease at diagnosis and a worsening diabetes control have been described.

Aim: To evaluate COVID-19 pandemic’s impact in incidence and presentation of T1D on paediatric patients.

Material and Methods: Retrospective analysis of newly-diagnosed T1D under 18years at our level-III hospital, between Jan2017-Dec2022. A demographic and clinical characterization was performed. Pre-pandemic (until Mar2020) and post-pandemic patients were compared. Statistical analysis was performed with IBM SPSS Statistics26.0.

Results: There were 127 new diagnoses of T1D, 63% male, median age 9,84years (0,84-17,82). Predominant symptoms were polydipsia (87%), polyuria (77%), weight loss (63%) and polyphagia (27%). 13% had a 1st or 2nd degree relative with T1D. At diagnosis, mean HbA1c was 11.73% (± 2.22), mean glycemia 484mg/dL (± 164), mean C-peptide 0,62ng/mL (± 0.58, low in 77%), mean insulin 3,5uUI/mL (± 4,26), mean eGFR 78,02mL/min/1,73m2 (<60 in 69%) and mean BUN 21,49mg/dL (±11,26, elevated in 48%). 32% patients had high total cholesterol, 21% elevated LDL and 63% hypertriglyceridemia. 99% had at least one type of auto-antibodies [90,5% GAD2 (n=106/117), 44% IAA (n=52/118), 63,5% ICA (n=75/118), 96% IA2 (n=48/50). 80% were COVID-vaccinated. 65% had COVID infection: 17% before T1D diagnosis, mean interval 138 days; and 7 patients tested positive at admission. There was a significant difference between pre- and post-pandemic groups: mean pH 7,31 vs 7,21 (P=0,018), mean HCO3- 20,7 vs 15,6mmol/L (P=0,002), mean ketonemia 3,1 vs 4,7mmol/L (P=0,004) and mean eGFR 84,9 vs 70mL/min/m2 (P=0,028), respectively. There was no significant difference between age at onset (P=0,617), symptom duration (P=0,277), mean HbA1c at diagnosis (P=0,804) and mean HbA1c one year after diagnosis (P=0,937). Incidence was 21 cases/year in both groups and cases were distributed throughout the year, with a non-consistent predominance in winter months (Jan-Mar). In the post-pandemic group, patients with/without COVID at T1D onset had no difference in presentation severity (P=0,787), duration of hospitalization (P=0,281) and disease control after one year (P=0,947).

Conclusion: There was no difference in incidence of T1D in pre- and post-pandemic groups. The post-pandemic group had a worse severity at admission, but without a longer admission or a worse metabolic control at 1 year. In this study, we highlight the importance of the initial admission and the need of an experienced team for optimal control.