We retrospectively analyzed the records of all patients aged 0–18 years who were diagnosed with hyperglycemia or DKA in the ER and/or those admitted to the ER and diagnosed with DKA at the time of discharge from 2017 to June 2020. Patient data were analyzed by the retrospective review of medical records. Anthropometric values were based on the data collected at the time of ER visit. Body mass index was calculated as weight (kg) divided by the square of height (m2). Typical symptoms of DKA, such as altered mental status, polyuria, polydipsia, weight loss, nausea, vomiting, abdominal pain, and dyspnea, were referred to the records of the pediatric emergency specialist at the time of the visit. The patients’ medical history was evaluated to determine if the DM was newly diagnosed and to determine the time from diagnosis to DKA. The hospitalization and discharge records were used to screen for severe DKA complications such as acute kidney injury (AKI), altered mental status, cerebrovascular attack, and death. The data on blood chemistry were based on tests performed immediately after ER admittance and included C-peptide, serum glucose, hemoglobin A1c (HbA1c), creatinine, arterial pH, bicarbonate, anion gap, and urine ketone measurements. To distinguish type 1 from type 2 DM, serum C-peptide, insulin, anti-insulin antibody, and islet cell antibody levels were used in two hospitals. AKI was defined as a glomerular filtration rate (GFR) of ≤90, which was calculated using the original Schwartz equation for patients aged ≤12 years and the Cockcroft–Gault equation for those aged 13–18 years.

Clinical characteristics and laboratory findings were compared among the years of admission, and complication rates were compared between the pre-COVID-19 period between 2017 and 2019 and the COVID-19 period in 2020. To determine the potential increase in DKA incidence during the COVID-19 pandemic, the ratio of patients with DKA to the Jeonbuk population and the ratio of patients with DKA to all patients who visited the two university hospitals for pediatric care were calculated.

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