Endocrine Abstracts

JOINT3013

Objectives: After several medical centres, including Children’s Clinical University Hospital (CCUH) in Latvia, had reported increase in type 1 diabetes (T1D) incidence in children during COVID-19 pandemic, our aim was to analyse influence of SARS-CoV-2 and pandemic itself on the control and course of T1D during the first year of disease.

Materials and Methods: Patients were included prospectively from August 2022 till January 2024, retrospectively from January 2017 until August 2022 and further divided depending on previous COVID-19 history: exposed to SARS-CoV-2 before T1D and unexposed patients. Data about initial manifestation and compensation measures 3, 6 and 12 months after diagnosis were gathered via interviews and medical records. Partial remission (PR) was defined by insulin doses <0. 5 IU/kg/day and HbA1c<7%. Complete remission (CR) was referred in patients with no requirement of insulin. Metabolic compensation (HbA1c) was also compared between pandemic and non-pandemic periods.

Results: In total, 277 patients were included in this study: 122 (44%) in exposed group (53. 3% boys, median age 9. 54 (IQR_1-3 5. 98-13. 27)), 155 (56%) in unexposed group (56. 8% boys, median age 10. 58 (6. 67-13. 42)). Initial manifestation of T1D was significantly more severe in patients previously exposed to SARS-CoV-2 (pH 7. 29 (7. 13-7. 37) vs pH 7. 33 (7. 19-7. 39)), P = 0. 02. SARS-CoV-2 exposed patients needed higher doses of insulin initially (0. 74 (SD±0. 27) IU/kg/day vs 0. 66 (±0. 27) IU/kg/day), P = 0. 02, but in 3-, 6- and 12-months requirement for insulin was similar in both groups. During the first year of T1D, PR was observed in 48 (39. 7%) exposed patients and 50 (33. 8%) unexposed patients, showing no significant difference (P = 0. 58). 2 patients in both groups had CR period. Overall patients who initially presented with diabetic ketoacidosis (DKA), had significantly lower prevalence of remission period during the first year (26. 1% vs 48. 9%, P = 0. 001). There was significantly higher frequency of DKA during one-year period in patients previously exposed to SARS-CoV-2 (6. 1% vs 0. 7%, v=0. 02). Comparison analysis of follow-up visits (3, 6 and 12 months after diagnosis) between pandemic and non-pandemic periods showed slightly higher HbA1c levels during COVID-19 pandemic, but results did not reach statistical significance.

Conclusion: New-onset T1D patients previously exposed to SARS-CoV-2 have more severe initial manifestation, but insulin dosages, prevalence of remission and HbA1c levels reach similar levels 3, 6 and 12 months after diagnosis. However, cause of significantly higher prevalence of DKA in SARS-CoV-2 exposed group during the first year of diabetes should be further analysed.