Impact of SARS-CoV-2 Infection on Diabetic Ketoacidosis in Children with Newly Diagnosed Type-1 Diabetes: A Prospective Multicenter Study.

Objective: The coronavirus disease pandemic has raised concerns about a possible link between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and both the development of type 1 diabetes (T1D) and increased rates and severity of diabetic ketoacidosis (DKA) at diagnosis. However, existing evidence is largely retrospective and inconclusive. This prospective multicenter study aimed to evaluate the association between SARS-CoV-2 infection and the rate and severity of DKA in children newly diagnosed with T1D and to assess the prevalence of SARS-CoV-2 exposure in this population. Methods: This study included 133 pediatric patients newly diagnosed with T1D across three tertiary centers in Türkiye between April 2021 and April 2022. SARS-CoV-2 status was determined at diagnosis using polymerase chain reaction and serological tests (IgM, IgG); IgG testing was repeated after 21 days. Patients were categorized into three groups: active infection, past infection, and no infection. The prevalence of SARS-CoV-2 exposure was also analyzed. Results: SARS-CoV-2 seropositivity was found in 39% of patients. DKA was present in 76.9% of those with active infection, 66.6% of those with past infection, and 54.3% of those without infection. Although DKA was more frequent in those with SARS-CoV-2 exposure, the difference was not statistically significant (p=0.240). DKA severity also showed no significant variation among groups (p=0.162). Conclusions: DKA was the predominant presentation regardless of SARS-CoV-2 status, with no significant difference in frequency or severity. These findings suggest that increased DKA rates may be more related to healthcare access issues during the pandemic than to direct viral effects.