INTRODUCTION: Objective: Diabetic ketoacidosis (DKA) a potentially preventable complication of Type 1 diabetes (T1D) is one of the
most common chronic childhood diseases, and is associated with a significant risk of morbidity and mortality. The limited
use of healthcare services due to fear of COVID-19 transmission during the pandemic has raised concerns of delays in T1D
diagnosis, among other diseases. This study investigates the presenting characteristics of newly diagnosed T1D patients
assessed in our clinic during the pandemic and compares them with the pre-pandemic period.
METHODS: Materials and Method: For the purpose of this study, the first year of the pandemic is referred to as the pandemic period,
and the previous three years as the pre-pandemic period. Patient files were reviewed retrospectively, the demographic and
clinical characteristics and laboratory findings of the patients were recorded, and the findings from both periods were
RESULTS: Results: The number of patients diagnosed with T1D was 44 in the pandemic period, and 39 in 2017, 22 in 2018 and 18 in
2019 in the pre-pandemic period. The two groups were noted to have similar age, sex, pubertal stage and anthropometric
characteristics (p > 0.05). Regarding the type of presentation, the frequency of DKA was significantly higher in the pandemic
period (68.2%) than in the pre-pandemic period (40.5%) (p = 0.006), and this difference was also observed in the comparison
by years (p = 0.016). The duration of symptoms (16.5±10.7 vs. 23.5±17.6 days) and the length of hospital stay (10±3.9 vs.
15.2±5.5 days) were significantly shorter in the pandemic period (p = 0.032, and p < 0.001, respectively). There was no
difference in the frequency of severe DKA between the pandemic (46.7%) and the pre-pandemic (37.5%) periods (p > 0.05).
However, pH (7.17±0.16 vs. 7.26±0.14) and bicarbonate (12.8±6.3 vs. 16.6±6.3) levels were significantly lower in the
pandemic period (p < 0.005). Additional signs of infection on admission were less frequent in the pandemic period (9.1%)
than in the pre-pandemic period (27.8%) (p = 0.027). The groups did not differ in terms of HbA1c, C-peptide, concurrent
thyroid autoantibodies and tissue transglutaminase antibodies (p > 0.05). The rate of anti-GAD positivity was higher in the
pandemic period (73.8% vs. 39.2%) (p = 0.001) while the frequency of other diabetes-associated autoantibodies was similar
between the groups (p > 0.05). The PCR test for COVID-19 was negative in six patients with a history of contact.
DISCUSSION AND CONCLUSION: Conclusion: We observed an increased frequency and severity of DKA in children with newly diagnosed T1D in the
pandemic period, and our findings justify our concerns related to the diagnosis of other diseases during the pandemic. Studies
to raise awareness of diabetes symptoms during the pandemic should be continued regularly to reach all segments of society.
Our study provides an additional contribution to the literature in its coverage of the one-year period during the pandemic and
its comparison with the previous three years.