The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020
Authors: Cherubini Valentino , Marino Monica , Scaramuzza Andrea E. , Tiberi Valentina , Bobbio Adriana , Delvecchio Maurizio , Piccinno Elvira , Ortolani Federica , Innaurato Stefania , Felappi Barbara , Gallo Francesco , Ripoli Carlo , Ricciardi Maria Rossella , Pascarella Filomena , Stamati Filomena A. , Citriniti Felice , Arnaldi Claudia , Monti Sara , Graziani Vanna , De Berardinis Fiorella , Giannini Cosimo , Chiarelli Francesco , Zampolli Maria , De Marco Rosaria , Bracciolini Giulia Patrizia , Grosso Caterina , De Donno Valeria , Piccini Barbara , Toni Sonia , Coccioli Susanna , Cardinale Giuliana , Bassi Marta , Minuto Nicola , D’Annunzio Giuseppe , Maffeis Claudio , Marigliano Marco , Zanfardino Angela , Iafusco Dario , Rollato Assunta S. , Piscopo Alessia , Curto Stefano , Lombardo Fortunato , Bombaci Bruno , Sordelli Silvia , Mameli Chiara , Macedoni Maddalena , Rigamonti Andrea , Bonfanti Riccardo , Frontino Giulio , Predieri Barbara , Bruzzi Patrizia , Mozzillo Enza , Rosanio Francesco , Franzese Adriana , Piredda Gavina , Cardella Francesca , Iovane Brunella , Calcaterra Valeria , Berioli Maria Giulia , Lasagni Anna , Pampanini Valentina , Patera Patrizia Ippolita , Schiaffini Riccardo , Rutigliano Irene , Meloni Gianfranco , De Sanctis Luisa , Tinti Davide , Trada Michela , Guerraggio Lucia Paola , Franceschi Roberto , Cauvin Vittoria , Tornese Gianluca , Franco Francesca , Musolino Gianluca , Maltoni Giulio , Talarico Valentina , Iannilli Antonio , Lenzi Lorenzo , Matteoli Maria Cristina , Pozzi Erica , Moretti Carlo , Zucchini Stefano , Rabbone Ivana , Gesuita Rosaria 
Published: June 2022

Aim/HypothesisTo compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019.MethodsForty-seven pediatric diabetes centers caring for &gt;90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019.ResultsOverall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p&lt;0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p&lt;0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively).Conclusions/InterpretationThere was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.