{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:26:37Z","timestamp":1787570797502,"version":"build-2736575974"},"reference-count":14,"publisher":"FapUNIFESP (SciELO)","issue":"8","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: The objective of this study was to identify the frequency and severity of diabetic ketoacidosis in the diagnosis of type 1 diabetes mellitus in the pre-, during-, and post-COVID-19 pandemic periods at a state-reference pediatric center.  METHODS: Observational, cross-sectional period study, including medical records of patients diagnosed with type 1 diabetes mellitus from 2018 to 2024. The association between the diagnosis period and the presence of diabetic ketoacidosis was assessed using odds ratios with 95%CIs. The association between the diagnosis period and the need for intensive care unit admission, symptom duration, and previous incorrect diagnoses was assessed using Fisher's exact test. Temporal trends in diabetic ketoacidosis severity were assessed using the Cochran-Armitage trend test. p&lt;0.05 were considered significant.  RESULTS: Of the 184 type 1 diabetes mellitus cases, 55.4% presented with diabetic ketoacidosis at diagnosis. Patients diagnosed during the pandemic had a higher chance of developing diabetic ketoacidosis compared to the pre-pandemic period (OR 3.17; 95%CI 1.52\u20136.64; p=0.002) and the post-pandemic period (OR 2.90; 95%CI 1.37\u20136.16; p=0.005). There was no significant association between the diagnosis period and the occurrence of previous incorrect diagnoses, between the diagnosis period and the time of symptom progression, and intensive care unit admission. Regarding the severity of diabetic ketoacidosis, no significant temporal trend was identified (p&gt;0.05).  CONCLUSION: An association was observed between the pandemic period and the occurrence of diabetic ketoacidosis, without inference of causality. There are no significant differences in the proportion of severe diabetic ketoacidosis during the pandemic period.<\/jats:p>","DOI":"10.1590\/1806-9282.20260238","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:08:30Z","timestamp":1787569710000},"source":"Crossref","is-referenced-by-count":0,"title":["Ketoacidosis at diagnosis of diabetes mellitus type 1: impact of the COVID-19 pandemic"],"prefix":"10.1590","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9217-5091","authenticated-orcid":false,"given":"Denise Bousfield da","family":"Silva","sequence":"first","affiliation":[{"name":"Universidade Federal de Santa Catarina,  Brazil; Universidade do Sul de Santa Catarina,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9942-7264","authenticated-orcid":false,"given":"R\u00fabia Caroline Paz Roseno da","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade Federal de Santa Catarina,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7389-985X","authenticated-orcid":false,"given":"Jefferson","family":"Traebert","sequence":"additional","affiliation":[{"name":"Universidade do Sul de Santa Catarina,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5374-3893","authenticated-orcid":false,"given":"Marilza Leal","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Universidade Federal de Santa Catarina,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"key":"ref1","series-title":"Endocrinologia pedi\u00e1trica","volume-title":"Cetoacidose diab\u00e9tica","author":"Alaves C","year":"2025","edition":"2nd ed."},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1111\/pedi.13406","article-title":"ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"23","author":"Glaser N","year":"2022","journal-title":"Pediatr Diabetes"},{"key":"ref3","series-title":"IDF diabetes atlas","year":"2025","edition":"11th ed."},{"issue":"11","key":"ref4","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S2213-8587(22)00246-7","article-title":"Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries","volume":"10","author":"Birkeb\u00e6k NH","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.2337\/dc25-S002","article-title":"2. Classification and diagnosis of diabetes: standards of care in diabetes\u20142025","volume":"48","year":"2025","journal-title":"Diabetes Care"},{"key":"ref6","series-title":"Pediatria b\u00e1sica. Tomo I: pediatria geral e neonatal","first-page":"3","author":"Marcondes E","year":"2002","edition":"9th ed."},{"key":"ref7","series-title":"Diretriz da Sociedade Brasileira de Diabetes","volume-title":"Diagn\u00f3stico de diabetes mellitus","author":"Rodacki M","year":"2025"},{"issue":"4","key":"ref8","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1111\/pedi.13205","article-title":"Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic","volume":"22","author":"Ho J","year":"2021","journal-title":"Pediatr Diabetes"},{"issue":"5","key":"ref9","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1038\/s41390-022-02241-2","article-title":"Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes","volume":"93","author":"Elgenidy A","year":"2023","journal-title":"Pediatr Res"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"669302","DOI":"10.3389\/fendo.2021.669302","article-title":"The impact of COVID-19 pandemic lockdown on the incidence of new-onset type 1 diabetes and ketoacidosis among Saudi children","volume":"12","author":"Alaqeel A","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"606018","DOI":"10.3389\/fendo.2021.606018","article-title":"Is misdiagnosis of type 1 diabetes mellitus in Malaysian children a common phenomenon?","volume":"12","author":"Mavinkurve M","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref12","article-title":"Type 1 diabetes often misdiagnosed in adults and children","author":"Tucker ME","year":"2019","journal-title":"Medscape Medical News"},{"issue":"3","key":"ref13","doi-asserted-by":"crossref","first-page":"276","DOI":"10.2337\/cd18-0088","article-title":"Misdiagnosis and diabetic ketoacidosis at diagnosis of type 1 diabetes: patient and caregiver perspectives","volume":"37","author":"Mu\u00f1oz C","year":"2019","journal-title":"Clin Diabetes"},{"issue":"2","key":"ref14","article-title":"Impact of the COVID-19 pandemic on the severity of diabetic ketoacidosis presentations in a tertiary pediatric emergency department","volume":"7","author":"Jafari K","year":"2022","journal-title":"Pediatr Qual Saf"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0104-42302026000802205&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:08:32Z","timestamp":1787569712000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302026000802205&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026]]}},"alternative-id":["S0104-42302026000802205"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.20260238","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e20260238"}}