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New-onset type 1 diabetes in Finnish children during the COVID-19 pandemic
  1. Heli Salmi1,2,
  2. Santtu Heinonen1,
  3. Johanna Hästbacka1,2,
  4. Mitja Lääperi1,
  5. Paula Rautiainen2,
  6. Päivi J Miettinen1,
  7. Olli Vapalahti3,4,5,
  8. Jussi Hepojoki3,6,
  9. Mikael Knip1,7
  1. 1New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  2. 2Department of Anesthesia and Intensive Care, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  3. 3Department of Virology, Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  4. 4HUSLAB, Helsinki University Hospital, Helsinki, Finland
  5. 5Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
  6. 6Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
  7. 7Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  1. Correspondence to Dr Heli Salmi, New Children's Hospital, Department of Anesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland; heli.salmi{at}hus.fi

Abstract

Background Viral infections may trigger type 1 diabetes (T1D), and recent reports suggest an increased incidence of paediatric T1D and/or diabetic ketoacidosis (DKA) during the COVID-19 pandemic.

Objective To study whether the number of children admitted to the paediatric intensive care unit (PICU) for DKA due to new-onset T1D increased during the COVID-19 pandemic, and whether SARS-CoV-2 infection plays a role.

Methods This retrospective cohort study comprises two datasets: (1) children admitted to PICU due to new-onset T1D and (2) children diagnosed with new-onset T1D and registered to the Finnish Pediatric Diabetes Registry in the Helsinki University Hospital from 1 April to 31 October in 2016–2020. We compared the incidence, number and characteristics of children with newly diagnosed T1D between the prepandemic and pandemic periods.

Results The number of children admitted to PICU due to new-onset T1D increased from an average of 6.25 admissions in 2016–2019 to 20 admissions in 2020 (incidence rate ratio [IRR] 3.24 [95% CI 1.80 to 5.83]; p=0.0001). On average, 57.75 children were registered to the FPDR in 2016–2019, as compared with 84 in 2020 (IRR 1.45; 95% CI 1.13 to 1.86; p=0.004). 33 of the children diagnosed in 2020 were analysed for SARS-CoV-2 antibodies, and all were negative.

Conclusions More children with T1D had severe DKA at diagnosis during the pandemic. This was not a consequence of SARS-CoV-2 infection. Instead, it probably stems from delays in diagnosis following changes in parental behaviour and healthcare accessibility.

  • COVID-19
  • endocrinology
  • health services research

Data availability statement

Data are available on reasonable request. Data collected for this study, including deidentified participant data and metadata that underlie the results reported in this article, may be shared with other investigators after approval of methodologically sound proposal. Proposals should be directed to corresponding author (ORCID 0000-0002-0565-0593). To gain access, data requestors will need to sign a data access agreement.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data are available on reasonable request. Data collected for this study, including deidentified participant data and metadata that underlie the results reported in this article, may be shared with other investigators after approval of methodologically sound proposal. Proposals should be directed to corresponding author (ORCID 0000-0002-0565-0593). To gain access, data requestors will need to sign a data access agreement.

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Footnotes

  • Twitter @HeinonenSanttu

  • HS and SH contributed equally.

  • Contributors HS and SH had full access to all of the data in the study. They take full responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: HS and SH (equal contribution). Acquisition, analysis or interpretation of data: PR (acquisition), JH (acquisition), MK (acquisition and interpretation), HS (acquisition, analysis and interpretation), SH (acquisition, analysis and interpretation), OV (acquisition and interpretation) and JH (acquisition and interpretation). Drafting of the manuscript: HS and SH (equal contribution), JH. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: ML. Obtained funding: PJM, SH and MK. Administrative, technical or material support: PR, MK, OV and JH. Supervision: MK.

  • Funding This work was supported by the Foundation for Pediatric Research (Lastentautien tutkimussäätiö, grant number 200059), Academy of Finland (grant number 323499) and the Pediatric Research Center (no specific grant number), all in Helsinki, Finland.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.