Endocrine Abstracts

Background: Paediatric emergency departments saw an unusual increased incidence and severity of DKA in children with new onset diabetes in the COVID pandemic. The DIMPLES study (Diabetes Mellitus in children and young people presenting to the Emergency Department during the SARS-CoV-2 pandemic) explored this using retrospective multicentre data from 49 EDs, providing a unique perspective of paediatric diabetes from the frontline.

Methods: We compared the characteristics of 2637 children (2746 attendances) aged 6 months-16 years presenting to EDs across UK and Ireland with new onset and pre-existing diabetes. Two distinct time periods of interest were chosen-March 1, 2020 to February 28, 2021, pandemic period, and March 1, 2019 to February 28, 2020, pre-pandemic period.

Results: There were increases in new onset diabetes (1,015 to 1,183; 17%), the vast majority of which were Type 1 diabetes. There were also increases in children presenting with DKA (395 to 566; 43%), severe DKA (141 to 252; 79%), and admissions to intensive care (38 to 72; 89%). There was a 31% reduction in children with pre-existing diabetes presenting with DKA. Time to presentation for children presenting with new onset diabetes and DKA were similar across both years. Healthcare seeking delay did not appear to be the sole contributing factor to DKA severity during the pandemic. There were no significant demographic differences in children between the two study years. The normal seasonal pattern of new onset Type 1 diabetes cases (winter peak with summer trough) was disrupted in the COVID pandemic year. 16/1028 children tested positive for SARS-CoV-2 on nasopharyngeal swabs, 13 presented with DKA. 37 children were tested for SARS-CoV-2 antibodies, eight were positive.

Conclusions: The DIMPLES study showed an increase in the number and severity of children presenting with new onset diabetes and DKA in the pandemic. Proving association or causation was challenging given the small number of children tested for COVID-19 antibodies. The causes of paediatric diabetes are complex however given the high incidence of new onset diabetes and the severity of DKA it is possible that SARS-CoV-2 may have a role as a precipitator or accelerator in a genetically predisposed child.