Ketoacidosis at diagnosis of diabetes mellitus type 1: impact of the COVID-19 pandemic.

OBJECTIVE: The objective of this study was to identify the frequency and severity of diabetic ketoacidosis in the diagnosis of type 1 diabetes mellitus in the pre-, during-, and post-COVID-19 pandemic periods at a state-reference pediatric center. METHODS: Observational, cross-sectional period study, including medical records of patients diagnosed with type 1 diabetes mellitus from 2018 to 2024. The association between the diagnosis period and the presence of diabetic ketoacidosis was assessed using odds ratios with 95%CIs. The association between the diagnosis period and the need for intensive care unit admission, symptom duration, and previous incorrect diagnoses was assessed using Fisher's exact test. Temporal trends in diabetic ketoacidosis severity were assessed using the Cochran-Armitage trend test. p<0.05 were considered significant. RESULTS: Of the 184 type 1 diabetes mellitus cases, 55.4% presented with diabetic ketoacidosis at diagnosis. Patients diagnosed during the pandemic had a higher chance of developing diabetic ketoacidosis compared to the pre-pandemic period (OR 3.17; 95%CI 1.52-6.64; p=0.002) and the post-pandemic period (OR 2.90; 95%CI 1.37-6.16; p=0.005). There was no significant association between the diagnosis period and the occurrence of previous incorrect diagnoses, between the diagnosis period and the time of symptom progression, and intensive care unit admission. Regarding the severity of diabetic ketoacidosis, no significant temporal trend was identified (p>0.05). CONCLUSION: An association was observed between the pandemic period and the occurrence of diabetic ketoacidosis, without inference of causality. There are no significant differences in the proportion of severe diabetic ketoacidosis during the pandemic period.