Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit

Abstract

Background: Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA. Methods: This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis. Both groups were examined in two subcategories (pandemic status: pre-pandemic vs. pandemic; and diabetes diagnosis status: previously diagnosed vs. newly diagnosed).Results: The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, creatinine, and alanine transaminase levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P=0.01, P=0.039, and p=0.001, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, p<0.005). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk Of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae. Conclusion: Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic. Although the reason for this is not fully known, it could be public health presentations were not effective during the coronavirus disease 2019 (COVID-19) period.