Diabetic ketoacidosis in youth with diabetes mellitus during the COVID-19 pandemic

Anna Cymbaluk; Xiaofan Huang; Charles Minard; Daniel DeSalvo; Maria J. Redondo

doi:10.1515/jpem-2024-0107

Article

Diabetic ketoacidosis in youth with diabetes mellitus during the COVID-19 pandemic

Anna Cymbaluk , Xiaofan Huang , Charles Minard , Daniel DeSalvo and Maria J. Redondo

Published/Copyright: August 1, 2024

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 37 Issue 9

Abstract

Objectives

We sought to determine if the early months of the coronavirus disease 2019 (COVID-19) pandemic influenced pediatric diabetic ketoacidosis (DKA) hospitalization characteristics.

Methods

This is a cross-sectional study of youth with laboratory-confirmed DKA admitted to a large tertiary children’s hospital in the USA. Data were collected from admissions in March through July 2019 and March through July 2020, respectively. We evaluated the clinical characteristics of hospitalization, including demographic data and DKA severity. We used univariable ordinal logistic regression followed by multiple ordinal logistic regression to adjust for potential confounders.

Results

We included 137 children with diabetes admitted for DKA in the relevant period in 2019 and 173 patients admitted for DKA in the same period in 2020. Hemoglobin A1C (HbA_1c) upon admission was higher in 2020 (median=12.2 %) than in 2019 (11.5 %, p=0.018). Children who were admitted with DKA in 2020 were less likely to be autoantibody positive than those in 2019 (83 vs. 91 %, p=0.028). In the univariable model, being admitted in 2020 was significantly associated with more severe DKA (p=0.038), as was HbA_1c (p=0.001). After adjusting for HbA_1c upon admission, admission year was no longer significantly associated with more severe DKA.

Conclusions

In this study of pediatric diabetes of any type and duration of diabetes, youth admitted for DKA at the start of the COVID-19 pandemic, compared with those admitted during the year before, were more likely to have autoantibody-negative diabetes and had significantly higher HbA_1c. Additionally, higher HbA_1c seemed to mediate more severe DKA during the pandemic.

Keywords: COVID-19 pandemic; diabetes ketoacidosis [DKA]; pediatric diabetes; type 1 diabetes; type 2 diabetes; youth with diabetes mellitus

Corresponding author: Maria J. Redondo, MD, PhD, MPH, Division of Pediatric Diabetes and Endocrinology, Texas Children’s Hospital, Houston, TX, USA, 77030; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA, E-mail: redondo@bcm.edu

Acknowledgments

We are grateful to the Texas Children’s Hospital, Baylor College of Medicine Pediatric Diabetes and Endocrinology Research Program for supporting this research project. We also acknowledge Anaemy Danner De Armas for logistical assistance and Bettina Siegel for editorial assistance.

Research ethics: The Baylor College of Medicine’s Institutional Review Board approved the study, protocol number H-47411.
Informed consent: Consent Informed consent was waived by the Baylor College of Medicine’s Institutional Review Board.
Author contributions: Anna Cymbaluk designed the study, collected the data, interpreted results, and wrote the manuscript. Xiaofan Huang and Charles Minard provided statistical analysis and aided in study design. Daniel DeSalvo contributed to the study design and revised the manuscript. Maria J. Redondo conceptualized the study, contributed to study design and data interpretation, supervised conduction of the study, and revised the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Received: 2024-03-01

Accepted: 2024-07-14

Published Online: 2024-08-01

Published in Print: 2024-09-25

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Articles in the same Issue

https://doi.org/10.1515/jpem-2024-0107

Keywords for this article

COVID-19 pandemic; diabetes ketoacidosis [DKA]; pediatric diabetes; type 1 diabetes; type 2 diabetes; youth with diabetes mellitus