Glycated hemoglobin at diagnosis of type 1 diabetes and at follow‐up in children and adolescents during the COVID‐19 pandemic in Germany

BACKGROUND: This study investigated the diagnostic delay and the subsequent quality of care during the Covid‐19 pandemic among children with new‐onset type 1 diabetes. METHODS: We compared the HbA(1c) levels of 3111 children at diagnosis of type 1 diabetes and of 2825 children at a median follow‐up of 4.7 months (interquartile range, 4.1–5.4) together with their daily insulin requirement during the Covid‐19 pandemic with the two previous years via multivariable linear regression, using data from the German Diabetes Registry DPV. RESULTS: During the Covid‐19 pandemic, HbA(1c) levels were higher at diagnosis of type 1 diabetes (mean estimated difference, 0.33% [95% confidence interval, 0.23–0.43], p < 0.001), but not at follow‐up (mean estimated difference, 0.02% [−0.02–0.07]). Children with diabetes onset during the Covid‐19 pandemic had a significantly higher daily insulin requirement after initiation of therapy (mean estimated difference, 0.08 U/kg [0.06–0.10], p < 0.001). Both the increase in HbA(1c) and daily insulin requirement were evident only after the first wave of the pandemic. CONCLUSIONS: This increase in HbA(1c) at diagnosis of type 1 diabetes during the Covid‐19 pandemic may indicate a delay in seeking medical care due to the pandemic. However, this did not affect short‐term glycemic control. The increased insulin requirement at follow‐up could suggest a more rapid autoimmune progression during the pandemic.