Increase in New-Onset Type 1 Diabetes, DKA in Kids During COVID Pandemic

Miriam E. Tucker

August 18, 2022

The study covered in this summary was published in Preprints with The Lancet and has not yet been peer reviewed.

Key Takeaways

  • Across sites in the UK and Ireland, there was an increase in new-onset pediatric diabetes and diabetic ketoacidosis (DKA) during the year of the early COVID-19 pandemic compared with the prior year.

  • Children with pre-existing diabetes had lower rates of attending the emergency department (ED) with DKA compared with the prior year.

  • The question of whether SARS-CoV-2 can trigger new-onset diabetes remains unanswered.

Why This Matters

  • Previous studies of new-onset type 1 diabetes in children have involved small cohorts and did not explore DKA incidence and severity in children with pre-existing type 1 diabetes during the COVID-19 pandemic.

Study Design

  • The DIMPLES study (Diabetes Mellitus in Children and Young People Presenting to the Emergency Department During the SARS-CoV-2 Pandemic) is a retrospective multicenter study conducted across 49 sites in the UK and Ireland.

  • Researchers compared characteristics of children aged 6 months to 16 years presenting to the ED with new-onset or pre-existing diabetes with DKA during the early COVID-19 pandemic (March 1, 2020 to February 28, 2021) with those of the preceding year (March 1, 2019 to February 28, 2020).

  • During the study period, there were 2746 ED visits by 2637 individuals.

Key Results

  • There was a 17% increase in new-onset diabetes from Year 1 to Year 2, mostly of type 1 diabetes.

  • ED visits for DKA dropped by 31.9% during the pandemic year among patients with existing diabetes.

  • There was a 43% increase in severity of new-onset disease from Year 1 to Year 2, with severe DKA increasing by 79% (P < .001) and intensive care admissions by 89% (P < .05).

  • Of the 873 children with new-onset diabetes, 12 tested positive for SARS-CoV-2. DKA was severe in four, moderate in three, and mild in three.

  • Of the 155 children with pre-existing diabetes, four tested positive for SARS-CoV-2. DKA was severe in two, moderate in one, and mild in one, and none had delayed presentation. 

  • Of 37 children tested for COVID antibodies, eight were positive.

  • There was no difference in median diagnostic interval for children presenting with new-onset diabetes during the pandemic compared with the prior year (both 14 days).


  • Data captured only those presenting to the ED.

  • Limited availability of SARS-CoV-2 testing may have led to underestimation of impact of virus on reported outcomes.


  • No study funding.

  • No author disclosures.

This is a summary of a preprint research study, "Children presenting with diabetes and diabetic ketoacidosis to emergency departments during the COVID-19 pandemic in the UK and Ireland: An international retrospective observational study," written by Caroline Ponmani, of the Department of Paediatric Emergency Medicine, Barking Havering and Redbridge University Trust, London UK, and colleagues and provided to you by Medscape. It has not yet been peer-reviewed.


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