Kamrath C, Rosenbauer J, Eckert AJ, et al. - According to the findings, the local severity of the pandemic, rather than health policy measures, seems to be the primary cause of the rise in diabetic ketoacidosis and, as a result, the delayed use of healthcare during the pandemic.

• The monthly relative risk (RR) for ketoacidosis in 2020 was calculated using observed and expected rates in 3,238 children with new-onset type 1 diabetes.

• From April to September, and again in December, the observed vs expected frequency of diabetic ketoacidosis was significantly higher.

• Each increase in the regional weekly incidence of COVID-19 by 50 cases or 1 death per 100,000 population during the first half of 2020 was associated with an increase in the RR of diabetic ketoacidosis of 1.40 and 1.23, respectively.

• This link was no longer visible in the second half of 2020.