Type 1 diabetes

Pandemic has not delayed T1D presentation: Australian centres

Unlike some overseas paediatric diabetes centres there has been no apparent reduction in new presentations of type 1 diabetes mellitus (T1DM) during the COVID-19 pandemic – at least during the initial period –  according to clinicians in Victoria.

Reports from Italy and the US have described delayed hospital presentations with severe diabetic ketoacidosis (DKA) at first presentation with T1DM during the COVID‐19 pandemic

But doctors from the Royal Children’s Hospital Melbourne and Monash Children’s Hospital, which manage about 80% of paediatric T1DM cases in Victoria, say there has been no change in either total numbers new presentations this year, nor the proportion presenting in DKA.

In an article published in the Journal of Paediatrics and Child Health, Dr Gabby Atlas and colleagues report the results of an audit conducted across both sites from February to May for the past four years.

It showed there was no change in annual number of new presentations of T1DM in 2020 compared to previous years, with 58 cases recorded, although there had been an unexplained increase in numbers for the single year of 2019.

Similarly, there was no apparent change in the severity of T1D at presentation as measured by the proportion of cases with DKA or the severity of DKA.

There was a two-fold increase in admissions of children with T1D to the intensive care unit (ICU) recorded, but this may have been due to increase in bed capacity from cancellation of surgery and reduced ED presentations for other conditions.

The article authors said any change in presentations should be seen in context of the overall incidence of paediatric T1DM increasing and numbers and severity of presentations fluctuating over time.

“Concerns regarding increased severity at presentation with paediatric T1DM (due a perceived reduction in access to health‐care services and broader community fear in the setting of the pandemic) have not been borne out in this data,” they wrote.

“The successful avoidance of the projected pandemic‐related health‐care crisis in Australia in the period reported herein may explain the difference compared to reports from more severely impacted regions,” they concluded, adding that the full impact of the COVID‐19 pandemic and government responses requires ongoing evaluation.

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