Increase in DKA at diabetes diagnosis shows delays in medical care during pandemic
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The frequency of diabetic ketoacidosis among children at type 1 diabetes diagnosis in Germany nearly doubled during the initial COVID-19-related lockdown compared with similar periods in 2018 and 2019, likely due to reduced medical services.
“Any barriers that delay the acute presentation to the health system, be it at a doctor's office or clinic, must be removed,” Clemens Kamrath, MD, a pediatric diabetologist with the Center of Child and Adolescent Medicine at Justus Liebig University in Giessen, Germany, told Healio. “More education is needed regarding the symptoms of the manifestation of type 1 diabetes, such as polyuria and polydipsia.”
According to a research letter published in JAMA, Kamrath and colleagues used the German Diabetes Prospective Follow-up Registry to analyze data of 532 children and adolescents (median age, 10 years; 61.5% boys) with newly diagnosed type 1 diabetes between March 13 — when most schools were closed to reduce interpersonal contacts — through May 13. DKA was defined as a pH level of less than 7.3 and/or a bicarbonate level less than 15 mmol/L; severe DKA was defined as a pH level of less than 7.1 and/or a bicarbonate level of less than 5 mmol/L. Researchers used logistic regression analysis to compare the frequencies of DKA and severe DKA observed with DKA incidence during the same 2-month periods in 2018 and 2019.
Within the cohort, DKA was present in 238 patients and severe DKA was observed in 103 patients.
The frequency of DKA — 44.7% — was significantly higher during the COVID-19 period compared with the 2 previous years. The DKA rate in 2019 was 24.5% in 2019, for an adjusted RR of 1.84 (95% CI, 1.54-2.21), and 24.1% in 2018, for an adjusted RR of 1.85 (95% CI, 1.54-2.24).
Incidence of severe DKA also was higher compared with the previous 2 years, with rates of 19.4% in 2020 vs. 13.9% in 2019 (adjusted RR = 1.37, 95% CI, 1.04-1.81) and 12.3% in 2018 (adjusted RR = 1.55; 95% CI, 1.15-2.1).
Children aged 6 years and younger had the highest risk for DKA, with rates of 51.9% in 2020 vs. 18.4% in 2019 (adjusted RR = 2.75; 95% CI, 1.88-4.02) and 24.2% in 2018 (adjusted RR = 2.12; 95% CI, 1.48-3.02). Results were similar for rates of severe DKA.
The researchers noted that underlying causes may be multifactorial and reflect reduced medical services, fear of approaching the health care system and more complex psychosocial factors.
“Educational campaigns regarding the symptoms of childhood diabetes are necessary,” Kamrath said. “Antibody screening programs should be expanded and evaluated. But the psychological factors that prevent an early presentation during the pandemic must also be better understood.”
For more information:
Clemens Kamrath, MD, can be reached at the Center of Child and Adolescent Medicine, Justus Liebig University, Feulgenstr 12, 35385 Giessen, Germany; email: clemens.kamrath@paediat.med.uni-giessen.de; Twitter: @jlugiessen.
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