A Comparative Study on Pediatric Diabetic Ketoacidosis Before and During the COVID-19 Pandemic in a Tertiary Care Centre in South India

IntroductionDiabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes mellitus in children.The COVID-19 pandemic disrupted healthcare access and diabetes care, potentially increasing the severity of pediatric DKA.This study compared the clinical profile, biochemical characteristics, complications and outcomes of pediatric DKA before and during the COVID-19 pandemic and evaluated the association of COVID-19 immunoglobulin G (IgG) status with disease severity and outcome. StudyThis hospital-based comparative cohort study was conducted at the Institute of Child Health and Hospital for Children, Egmore, Chennai.Children aged one month to 12 years admitted with DKA during 2019 (pre-COVID, n=58) and 2021 (COVID era, n=78) were included.Demographic, clinical, biochemical and outcome parameters were compared.During 2021, SARS-CoV-2 IgG antibody status was also assessed. ResultsA total of 136 children were studied.The mean age and duration of hospital and ICU stay were comparable between the groups.Admission blood glucose was significantly higher in 2019 (482.6±112.9vs 433.0±121.2mg/dL; p=0.016), whereas glycatd hemoglobin (HbA1c) was significantly higher in 2021 (11.83±3.15vs 10.81±2.49%;p=0.044).Sepsis was significantly more frequent during the COVID era (35.1% vs 15.5%; p=0.011).Decreased urine output was also significantly more frequent in 2021.Acute kidney injury, cerebral oedema, mechanical ventilation and poor outcomes were numerically higher during the COVID period but did not reach statistical significance.COVID-19 IgG positivity was not significantly associated with DKA severity, complications or outcome.Severe metabolic acidosis, renal dysfunction, hypernatremia and major complications were strongly associated with poor outcome. ConclusionThe COVID-19 pandemic was associated with poorer glycaemic control and increased sepsis among children presenting with DKA.Previous SARS-CoV-2 exposure did not independently influence disease severity or outcome.Early recognition, prompt treatment and uninterrupted diabetes care are essential to reduce adverse outcomes.