During COVID-19, healthcare systems reorganized with less ambulatory care and a shift to virtual care (1). There was an increase in diabetic ketoacidosis (DKA), a preventable, life-threatening condition, at diabetes onset in children during COVID-19 (2). DKA at diabetes onset has been attributed to delays in seeking care, missed diagnosis or delays in referral following a primary healthcare contact (3). Reasons for the recent increase in DKA may relate to hesitancy to seek care, providers failing to recognize diabetes symptoms due to cognitive bias focusing on COVID-19, or limitations of virtual care. To explore these potential mechanisms, we compared in-person and virtual primary care and emergency department (ED) visits in children four weeks prior to diagnosis, before and during COVID-19. If increased DKA rates during COVID-19 were due to more missed diagnoses, possibly related to virtual visits, children with DKA would be more likely to have visits during vs. pre-COVID-19. If families were hesitant to seek or unable to access care during COVID-19, then among those with no visits, there would be a higher proportion with DKA.

中文翻译：

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COVID 之前和期间儿童糖尿病诊断之前的医疗保健使用。

在 COVID-19 期间，医疗保健系统进行了重组，减少了门诊护理并转向虚拟护理 (1)。在 COVID-19 期间儿童糖尿病发病时，糖尿病酮症酸中毒 (DKA) 增加，这是一种可预防的危及生命的疾病 (2)。糖尿病发病时的 DKA 归因于寻求护理的延迟、漏诊或初级保健接触后的转诊延迟 (3)。最近 DKA 增加的原因可能与寻求护理犹豫不决、提供者由于侧重于 COVID-19 的认知偏见而未能识别糖尿病症状或虚拟护理的限制有关。为了探索这些潜在机制，我们比较了儿童在诊断前 4 周、COVID-19 之前和期间的面对面和虚拟初级保健和急诊 (ED) 访问。如果 COVID-19 期间 DKA 率增加是由于更多的漏诊（可能与虚拟就诊有关），那么与 COVID-19 之前相比，患有 DKA 的儿童更有可能在 COVID-19 期间进行就诊。如果家庭在 COVID-19 期间对寻求或无法获得护理犹豫不决，那么在没有就诊的家庭中，患有 DKA 的比例会更高。