506 Characteristics of new-onset paediatric Type 1 diabetes in the COVID-19 pandemic – a multicentre perspective

Abstract

<h3>Background</h3> Paediatric diabetes has been the focus of attention during the COVID-19 pandemic for several reasons. There was a reported increase in the incidence of new-onset type 1 paediatric diabetes in the pandemic and concerns that the incidence was related to an infection or a dysregulated immune response to SARS-CoV-2.Studies have also reported 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 diabetic ketoacidosis in children with new-onset diabetes.If it is proven that the perceived increased incidence of paediatric diabetes is related to an infection with SARS-CoV-2, this has implications for enhancing public and clinician awareness of diabetes resulting in early recognition and prevention of DKA. <h3>Objectives</h3> 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. <h3>Methods</h3> 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. Data from the same time period in 2019 was compiled for comparison.We compared the characteristics of 178 children presenting with new-onset type 1 diabetes between January and July 2020 (time period of interest) with those of 150 children who presented during the same period in 2019. <h3>Results</h3> There was a statistically significant increase in the number of children with new-onset type 1 diabetes presenting with DKA in 2020 when compared to 2019 (79 versus 49, p &lt;0.05). There was also an increase in the number of children presenting in severe DKA in 2020 when compared to 2019 (36 versus 16). 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, who were both from inner city localities with a highly diverse ethnic mix. Association with COVID-19 could not be ascertained from the children tested for SARS-CoV-2 by NPA RT PCR and serology.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 48% 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 a rapid loss of β-cells contributing to the rise in incidence and severity of DKA also accelerating the development of new-onset diabetes. <h3>Conclusions</h3> There was increased incidence and severity of DKA during the study period in 2020.Our study did not provide evidence that the COVID-19 pandemic is leading to a marked increase in incidence of pediatric type 1 diabetes.