Ketoacidosis in new-onset type 1 diabetes: return to pre-COVID-19 pandemic reality?

Rita Gomes Alvelos; Paula Santos; Mariana Sebastião; Catarina Tavares; Inês Barros Rua; Joana Serra-Caetano; Rita Cardoso; Isabel Dinis; Alice Mirante

doi:10.5114/pedm.2026.159708

eISSN: 2083-8441
ISSN: 2081-237X

Pediatric Endocrinology Diabetes and Metabolism

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abstract:

Original paper

Ketoacidosis in new-onset type 1 diabetes: return to pre-COVID-19 pandemic reality?

Rita Gomes Alvelos

^{1, 2}

,

Paula Santos

^{2, 3}

,

Mariana Sebastião

²

,

Catarina Tavares

^{2, 4}

,

Inês Barros Rua

²

,

Joana Serra-Caetano

²

,

Rita Cardoso

²

,

Isabel Dinis

²

,

Alice Mirante

²

Department of Paediatrics, Unidade Local de Saúde Região de Aveiro, Portugal
Paediatric Endocrinology, Diabetes and Growth Unit, Hospital Pediátrico de Coimbra, Unidade Local de Saúde de Coimbra, Portugal
Department of Paediatrics, Unidade Local de Saúde do Médio Tejo, Torres Novas, Portugal
Department of Paediatrics, Unidade Local de Saúde Viseu Dão-Lafões, Viseu, Portugal

Pediatr Endocrinol Diabetes Metab 2026; 32 (1): 32-37

DOI: https://doi.org/10.5114/pedm.2026.159708

Online publish date: 2026/03/30

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Introduction
Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases in childhood, with its incidence increasing globally. The coronavirus disease 2019 (COVID-19) pandemic has been associated with an increase in severity of cases of diabetic ketoacidosis.

Aim of the study
Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases in childhood, with its incidence increasing globally. The coronavirus disease 2019 (COVID-19) pandemic has been associated with an increase in severity of cases of diabetic ketoacidosis.

Material and methods
A retrospective cohort study was conducted, using patients’ clinical records, between March 2016 and March 2024. The sample was divided in three groups: pre-pandemic (March 2016 to March 2020), pandemic (March 2020 to March 2021), and post-pandemic (March 2021 to March 2024).

Results
A retrospective cohort study was conducted, using patients’ clinical records, between March 2016 and March 2024. The sample was divided in three groups: pre-pandemic (March 2016 to March 2020), pandemic (March 2020 to March 2021), and post-pandemic (March 2021 to March 2024).

Conclusions
There was an improvement in the post-pandemic period, with a lower severity at presentation. However, the rate of ketoacidosis remained high, and the focus must remain on implementing preventative measures.

keywords:

Ketoacidosis in new-onset type 1 diabetes: return to pre-COVID-19 pandemic reality?

Rita Gomes Alvelos 1, 2 , Paula Santos 2, 3 , Mariana Sebastião 2 , Catarina Tavares 2, 4 , Inês Barros Rua 2 , Joana Serra-Caetano 2 , Rita Cardoso 2 , Isabel Dinis 2 , Alice Mirante 2

diabetes mellitus type 1, diabetic ketoacidosis, COVID-19

Rita Gomes Alvelos

^{1, 2}

,

Paula Santos

^{2, 3}

,

Mariana Sebastião

²

,

Catarina Tavares

^{2, 4}

,

Inês Barros Rua

²

,

Joana Serra-Caetano

²

,

Rita Cardoso

²

,

Isabel Dinis

²

,

Alice Mirante

²