Increased Severity of New-onset Type 1 Diabetes in Children and Adolescents during the COVID-19 Pandemic: Experience from a Tertiary Care Center in Serbia

Background and objectives: Public health measures, parental fear of infection, and redeployment of medical resources in response to the COVID-19 pandemic might have led to a decrease in pediatric healthcare access. As a result, a delay in type 1 diabetes diagnosis might have occurred, leading to the worsening of its clinical presentation in the pediatric population. This study aimed to examine the clinical and biochemical features of new-onset DM1 in children and adolescents during the COVID-19 pandemic, comparing it to the pre-pandemic period. Materials and methods: The clinical and biochemical features of diabetes observed during the COVID-19 period from April 1, 2020, until December 31, 2022, were compared with the period from April 1, 2017, until December 31, 2019. In the COVID-19 pandemic group, the clinical and biochemical features were compared between children with and without SARS-CoV-2 infection at diagnosis or before the diagnosis of DM1. Results: During the COVID-19 pandemic, observed frequencies of DKA and severe DKA at diagnosis were 47.6% and 20.7%, both significantly higher than during the pre-pandemic period (an absolute increase of 15% and 11.3%, respectively). In the COVID-19 group, blood pH levels were significantly lower than in the pre-pandemic group, while HbA1c levels were higher. Clinical and biochemical features of diabetes in children with SARS-CoV-2 infection at or before the diagnosis were not significantly different compared to children without an infection. Conclusion: We report a significant worsening of the clinical presentation of new-onset type 1 diabetes and an increase in the frequency of DKA and severe DKA at diagnosis during the COVID-19 pandemic. Further studies are necessary to gain quantitative insight into pediatric healthcare availability in Serbia. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of the University Children's Hospital, Belgrade gave ethical approval for this work (protocol code 130-26/21) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data is unavailable due to privacy and ethical restrictions