DOES THE INCIDENCE OF DIABETIC KETOACIDOSIS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS DIFFER DURING COVID-19 PANDEMIC?

Abstract

INTRODUCTION
Recent studies have observed increased numbers of newly diagnosed type 1 diabetes patients and higher incidence of diabetic ketoacidosis in T1DM patients during the COVID-19 pandemic. The care of non-COVID-19 patients was compromised due to the tremendous burden of managing critical cases of COVID-19 patients. However, this finding is not consistent. This study compares the incidence of DKA and its severity during the pandemic with the similar timing prior to it.

METHODOLOGY
This is a retrospective cross-sectional study on all of patients who were either newly diagnosed or pre-existing patients with T1DM aged one to 18 years old treated at University Malaya Medical Centre for  DKA. from September 2017 until August 2022. Data on demographics, first DKA presentation, recurrence, severity, pediatric ICU admission, duration of recovery, COVID-19 status, duration from symptoms to presentation, and biochemical values were obtained.

RESULT
A total of 96 DKA cases were reported from September 2017 until August 2022. An equal number of DKA cases (48) was seen in each period. Fifty patients (69%) were newly diagnosed. Recurrent DKA occurred more during the COVID-19 period (27 versus 21). More patients presented with severe DKA during the pandemic (24 versus 19). Although not statistically significant, newly diagnosed T1DM presented with more severe DKA with lower pH (7.05 versus 7.12, p=0.417) and took longer to recover compared to the pre-pandemic period (48 versus 36 hours, p=0.150). Three newly diagnosed patients were COVID-19
positive with COVID-19 Category 2b and presented in moderate to severe DKA.

CONCLUSION
There was no difference in the number and severity of DKA cases during the pre-pandemic and COVID-19 pandemic period. A larger-scale study is needed to analyse the impact of COVID-19 on the incidence and severity of DKA.