195 - DKA Incidence and Severity in the Pediatric Population During the COVID-19 Pandemic

Poster Number: 195
Publication Number: 195.214

Elyzabeth Amador, University of Maryland Children's Hospital, Baltimore, MD, United States; Kaitlin Jeffries, University of Maryland Children's Hospital, Baltimore, MD, United States; Erin Bewley, University of Maryland Medical Center - Baltimore City, MD, Baltimore, MD, United States; Stefanie Z. Fischell, University of Maryland School of Medicine, Darnestown, MD, United States; Paula Newton, University of Maryland School of Medicine, Laurel, MD, United States

Background: Diabetic ketoacidosis (DKA) is a common complication of uncontrolled diabetes mellitus. Since March 2020, our institution has observed an increase in the relative number of DKA cases and the severity of illness in our pediatric population when compared to previous years.  Current literature supports this theory with data indicating more severe cases of DKA during the COVID-19 pandemic.  

Objective: The objective of this study is to evaluate the incidence and severity of DKA admissions to our institution during the COVID-19 pandemic as compared to previous years.

Design/Methods: We performed a chart review of all cases admitted to the PICU from March 2016-December 2017 and compared them to cases during the COVID-19 Pandemic from March 2020- December 2021. There were 213 cases, 128 in the pre-pandemic subgroup and 85 in the pandemic subgroup. We performed chi-squared analysis and unpaired t-tests 2 tailed in the analysis of the data.

Results: There was a significant shift to more severe DKA based on admission pH in all patients during COVID-19 as compared to pre-COVID-19 (p=0.032). In White patients, there was no significant change in DKA severity pre-COVID compared to during the pandemic.  Black patients, however, did have a significant increase in severity based on pH during COVID-19 compared to pre-pandemic(p=0.016), and there was a significant shift toward more severe DKA in Black patients compared to white patients during COVID-19 (p=0.010). Pre-COVID, there was no significant difference in DKA severity between White and Black patients (p=0.089).  There was no significant difference in admission blood glucose in Black patients (p=0.923) or White patients (p=0.466) since the start of COVID. The mean A1c on admission was significantly increased in Black patients (p=0.033) [13.01% vs 12.05%], but not White patients (p=0.980) [12.02% vs 12.01%] during COVID compared to pre-COVID.

Conclusion(s): Using admission pH to classify DKA severity, there was an increased incidence of severe DKA during the COVID-19 pandemic. This shift was driven by a significant increase in severe DKA in Black patients. Additionally, Black patients had a higher A1C on presentation during the COVID-19 pandemic compared to pre-pandemic. Further investigation is necessary to determine what factors influenced these results, but the highest concern is that the pandemic worsened pre-existing barriers to care for this population.  The study underscores the importance of educating the public on the signs and symptoms of DKA and continuing to improve access to healthcare for underrepresented minorities.