Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?

<div><b>Objective</b>: To evaluate if the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the COVID-19 pandemic in Italy.<b><br></b></div><div><b>Research Design and Methods</b>: This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetes ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between February 20 and April 14 in 2019 and 2020. </div><div><b>Results</b>: 53/68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared to 2019. Among those newly diagnosed patient who presented in DKA, the proportion with severe DKA was 44.3% in 2020 vs 36.1% in 2019, p = 0.03. There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed SARS-CoV-2.<b><br></b></div><div><b>Conclusions</b>: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any “second wave” requires strategies to educate and reassure parents about timely ED attendance for non-COVID-19 symptoms.</div>