Abstract
Background: Increases in incidence rates for type 1 diabetes have been observed internationally in association with the COVID-19 pandemic.1 2 Children with type 1 diabetes have been noted to present with more severe symptoms during the pandemic than before it.2 During the 2020 nationwide lockdown paediatricians reported cases of diabetic ketoacidosis that may have resulted from delay in seeking medical care.3 The proportion of new-onset diabetes hospitalisations with DKA at Starship was stable prior to 2013.4
Methods: Administrative data on first hospitalisations with type 1 diabetes in children aged under 15 years in Aotearoa from 2014–2022 were analysed. The proportion of these first hospitalisations with diabetic ketoacidosis was calculated using the DKA subcode. The proportions of first hospitalisations with DKA were compared for the six years before the COVID-19 pandemic (2014–2019) and the years 2021–2022 after widespread community transmission of COVID-19 first occurred in Aotearoa.
Results: From 2014–2022 there were 2,165 first hospitalisations for diabetes of children aged under 15 years, of which 773 (36%) were coded as DKA. The proportion of first hospitalisations for diabetes with a DKA subcode increased from 33.3% in 2014–2019 to 43.3% in 2021–2022 (p < .01). An increase in the proportion of first hospitalisations presenting with DKA was seen in all New Zealand Index of Deprivation (NZDep) quintiles. Regression analysis indicated that only discharge year was a significant predictor of DKA status (p = .02) and there was no independent effect of deprivation.
Conclusion: The proportion of children presenting with DKA at their first hospitalisation for type 1 diabetes increased in Aotearoa following widespread community transmission of COVID-19. Reasons for this are unclear. There are important implications for health service planning with a need to ensure adequate resources for intensive acute care and ongoing management.