A Multi-Centre Service Evaluation of Presentation of Newly Diagnosed IDDM in Children in the U.K. during the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic led to major changes in the pattern of presentation to Emergency Departments.This prompted concern within Paediatrics that this altered behaviour could lead to delays in the diagnosis of life-threatening conditions such as IDDM. A multicentre study was conducted to determine the incidence, referral patterns and severity of disease at presentation of this condition.

Methods: This was a U.K.-based multi-centre quality improvement project. It involved paediatric patients with a new diagnosis of type 1 diabetes who attended four treatment centres between 1st January - 31st July 2019 and the corresponding period in 2020. Assessments were made of presentations of the condition pre- (Jan-Mar) and post- (Apr-Jul) lockdown in 2020. A standard proforma was used to collect demographic and clinical data. This allowed total diagnostic interval (T.D.I) and patient interval (P.I.) to be calculated.

Results: Fewer new cases of type 1 diabetes were diagnosed post-lockdown compared with the identical period in 2019 in three of the four units studied. The median T.D.I. and P.I. were significantly lower during the period of lockdown than in the preceding three months of 2020 (p value = 0.039 and p=0.025) respectively. There was no significant difference in the proportion of patients presenting with diabetic ketoacidosis (DKA), nor in the requirement for PICU admission or for ventilatory support. Patients were more likely to present with severe DKA post-lockdown compared with the other time periods. This difference was not however statistically significant. There was also evidence of change having occurred in the route to diagnosis for children with diabetes post-lockdown in that they were more likely to have presented via the Emergency Department.

Conclusions: The study demonstrated that there was no impairment of systems' ability to make the diagnosis of type 1 diabetes in children the U.K. during the initial phase of the national public health response to the COVID-19 pandemic in 2020. It fully validated the narrative of the RCPCH and others in urging parents/caregivers to continue to promptly access medical services for their children. This provided an immensely positive message at a time of great public uncertainty.

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https://discovery.dundee.ac.uk/en/publications/608c1cd5-001f-4c6b-b29d-1d6738221250