Has variable access to health care during the COVID-19 pandemic impacted the severity of paediatric diabetic ketoacidosis?

Abstract

Previous studies have indicated that paediatric patients with type 1 diabetes mellitus are presenting with more severe diabetic ketoacidosis (DKA) during the COVID-19 pandemic. This study was performed to determine the effect that access to health care had on DKA severity and outcomes in children and young people (CYP) with new-onset diabetes mellitus. This is a retrospective cohort analysis comparing pre-pandemic and pandemic patients admitted to a 30-bed paediatric intensive care unit (PICU) in the United States with DKA. A database query identified patients and clinical data were extracted and analysed. Additionally, phone interviews focusing on challenges with health care access during the COVID-19 pandemic were performed with the parents of CYP admitted during the pandemic. A total of 50 pre-pandemic and 43 pandemic patients met inclusion criteria and were included in the analysis. Pandemic patients had more severe acidosis (pH 7.10 versus 7.17), a longer duration of insulin infusion (19 versus 15 hours) and increased PICU length of stay (1 versus 0.75 days, all p < 0.05) than pre-pandemic patients. Patients whose families felt the pandemic affected their child's ability to see a physician had a longer PICU length of stay (1.5 versus 0.9 days, p = 0.004) and a trend towards a lower pH (7.01 versus 7.13, p = 0.106). Patients with a social vulnerability index ≥0.75 were less likely to see a physician before coming to the hospital (p = 0.017). In conclusion, CYP with new-onset type 1 diabetes who were admitted with DKA during the COVID-19 pandemic had more severe acidosis and a longer PICU stay. Variable access to health care during the COVID-19 pandemic may be contributing to this. Copyright © 2022 John Wiley & Sons.