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Increase in Ketoacidosis in Children and Adolescents during the Corona Crisis

What impact was observed on the number of cases of ketoacidosis in young people with newly diagnosed diabetes during the first two months of the COVID 19 pandemic in Germany? DZD scientist Prof. Dr. Reinhard Holl from the University of Ulm and a team of researchers from all over Germany investigated this question. The results have now been published in the scientific journal JAMA. The background to the investigation was the general decrease in the number of visits to doctors, which potentially led to delayed medical diagnoses.

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The researchers compared the occurrence of diabetic ketoacidosis1 and severe diabetic ketoacidosis between March 13 and May 13 of this year, when most schools and kindergartens were closed due to the coronavirus, with the respective periods of the last two years. The data were taken from the German Diabetes Prospective Follow-up Registry (DPV), in which nationwide over 90 percent of children and adolescents with type 1 diabetes are recorded.

The data on 532 children and adolescents with newly diagnosed type 1 diabetes from 216 diabetes centers were analyzed. 238 patients (44.7%) had diabetic ketoacidosis and 103 (19.4%) had severe diabetic ketoacidosis. These figures were significantly higher than in the two previous years: (24.5% in 2019 and 24.1% in 2018 for diabetic ketoacidosis and 13.9% in 2019 and 12.3% in 2018 for severe diabetic ketoacidosis). Children under 6 years of age were most affected.

The reasons for this increase may be complex, but they reflect the reduced medical services available and the fear of using them during the COVID 19 pandemic. Although the socio-economic status and a possible hereditary predisposition were disregarded in this study, the authors led by PD Dr. Clemens Kamrath of the University Children's Hospital in Giessen, Germany, discuss better training of the specialist staff and beta cell antibody screening as ways of reducing diabetic ketoacidosis rate at manifestation.

1Diabetic ketoacidosis is a life-threatening condition that often occurs in people with type 1 diabetes who have not yet been diagnosed (pH value below 7.3 or bicarbonate level below 15mmol/l and in severe diabetic ketoacidosis pH value below 7.1 or bicarbonate level below 5mmol/l). The cause is an increased concentration of ketone bodies, which leads to a dangerous acidification of the blood. This is caused by insulin deficiency due to a strongly increased blood sugar level. The sugar from the blood no longer reaches the body cells, which therefore lack energy for the metabolic processes. In order to cover the energy requirement, a breakdown of fatty tissue is initiated. The fatty acids thus produced are incompletely broken down into so-called ketone bodies, which are exhaled (sweetish smell) and excreted with the urine (increased urge to urinate). Dehydration and cardiovascular failure are likely to occur. If no countermeasures are taken, ketoacidosis leads to a diabetic coma, in the worst case to death in the absence of treatment.

Original publication:
Kamrath, C. et al. Ketoacidosis in Children and Adolescents With Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic in Germany. JAMA 2020. doi:101001/JAMA.2020.13445