P2A294: COVID-19 Pandemic Duplicates Cases of Diabetic Ketoacidosis in Hispanic Patients Admitted to a Teaching Hospital

Background: Since COVID-19 pandemic, different countries have identified an increase in cases of
children with Diabetic Ketoacidosis (DKA). Access to primary care physicians and subspecialties were limited during the pandemic and most of them gave telemedicine care to their patients. We evaluated the impact of COVID-19 pandemic on DKA admissions in a
Pediatric Intensive Care Unit (PICU) in a teaching hospital on the prevalence and clinical
outcome of patients admitted with the disease.

Methods: In this retrospective study, we evaluated patients from 0-21 years of age with an official
diagnosis of DKA 18 months before pandemic (August 2018-February 2020), and 18 months
during pandemic (March 2020-October 2021) from PICU patients logbook. Data were
expressed as medians ± SD as appropriate. To compare the prevalence of DKA before and
during COVID-19 pandemic, a Fisher Exact Test was used for proportions and categorical
data. A Mann-Whitney test was used to analyze quantitative variables. A p-value < 0.05 was
established as statistically significant.

Results: A total of 128 patients were evaluated. Pre-pandemic, the median age was 15 ± 4.7 years and the median PICU total length of stay was 1 ± 2 days. During the pandemic, the median age was 14 ± 4.5 years and the PICU total length of stay was 1 ± 1.3 days. Previous COVID-19
pandemic there were 42% of DKA patients admitted to PICU vs 58% during COVID-19
pandemic (p=0.01). There was a significant difference between DKA cases before and during
pandemic.

Conclusion: The lockdown and limited access to medical care services due to the COVID-19 pandemic
produced delayed treatment, leading to increased cases of DKA and severely affecting the
health of chronic diseases such as diabetes. Physical encounters with physicians contribute to an appropriate follow-up of patients. Since there was no severity trend in pediatric patients in the first few months, medical care strategies should be considered for this population. It’s not excluded that the severity of DKA disease was due to the lack of compliance by children with respect to their feeding and stabilization with medications in the pandemic period. Future management of chronic disease in children could include appropriate coordination between patient and primary care physician to ensure the availability of medications, adherence to treatment regimens, and knowledge of which hospitals can appropriately treat the disease.