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Impact of SARS-CoV-2 Infection on Diabetic Ketoacidosis in Children with Newly Diagnosed Type-1 Diabetes: A
Merve Nur Hepokur1, Filiz Tutunculer Kokenli2, Hamdi Cihan Emeksiz1
1Istanbul Medeniyet University Faculty of Medicine, Goztepe Prof. Dr. Suleyman Yalcın City Hospital, Department of Pediatric Endocrinology, Istanbul, Türkiye.
Insights
This study found no significant link between SARS-CoV-2 infection and diabetic ketoacidosis (DKA) rates or severity in children with new-onset type 1 diabetes (T1D). DKA prevalence was similar across infection statuses, suggesting other factors influenced DKA presentation during the pandemic.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Immunology
Background:
- Concerns exist regarding SARS-CoV-2 infection's impact on type 1 diabetes (T1D) development and diabetic ketoacidosis (DKA) presentation.
- Existing evidence linking SARS-CoV-2 to T1D and DKA is largely retrospective and inconclusive.
Purpose of the Study:
- To prospectively evaluate the association between SARS-CoV-2 infection and DKA rate and severity in children newly diagnosed with T1D.
- To assess the prevalence of SARS-CoV-2 exposure in pediatric T1D patients.
Main Methods:
- A prospective multicenter study involving 133 pediatric patients newly diagnosed with T1D.
- SARS-CoV-2 status determined by PCR and serological tests (IgM, IgG) at diagnosis, with repeat IgG testing.
- Patients categorized into active infection, past infection, and no infection groups.
Main Results:
- SARS-CoV-2 seropositivity was observed in 39% of patients.
- DKA was present in 76.9% with active infection, 66.6% with past infection, and 54.3% without infection.
- No statistically significant differences in DKA frequency (p=0.240) or severity (p=0.162) were found among groups.
Conclusions:
- Diabetic ketoacidosis (DKA) was the primary presentation in pediatric T1D regardless of SARS-CoV-2 status.
- Findings suggest that pandemic-related healthcare access issues, rather than direct viral effects, may explain increased DKA rates.
- Further research is needed to fully understand the interplay between viral infections and T1D onset and presentation.
Objective:
The coronavirus disease pandemic has raised concerns about a possible link between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and both the development of type 1 diabetes (T1D) and increased rates and severity of diabetic ketoacidosis (DKA) at diagnosis. However, existing evidence is largely retrospective and inconclusive. This prospective multicenter study aimed to evaluate the association between SARS-CoV-2 infection and the rate and severity of DKA in children newly diagnosed with T1D and to assess the prevalence of SARS-CoV-2 exposure in this population.
Methods:
This study included 133 pediatric patients newly diagnosed with T1D across three tertiary centers in Türkiye between April 2021 and April 2022. SARS-CoV-2 status was determined at diagnosis using polymerase chain reaction and serological tests (IgM, IgG); IgG testing was repeated after 21 days. Patients were categorized into three groups: active infection, past infection, and no infection. The prevalence of SARS-CoV-2 exposure was also analyzed.
Results:
SARS-CoV-2 seropositivity was found in 39% of patients. DKA was present in 76.9% of those with active infection, 66.6% of those with past infection, and 54.3% of those without infection. Although DKA was more frequent in those with SARS-CoV-2 exposure, the difference was not statistically significant (p=0.240). DKA severity also showed no significant variation among groups (p=0.162).
Conclusions:
DKA was the predominant presentation regardless of SARS-CoV-2 status, with no significant difference in frequency or severity. These findings suggest that increased DKA rates may be more related to healthcare access issues during the pandemic than to direct viral effects.
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