Kamrath C, Mönkemöller K, Biester T, et al. - Using data from the German Diabetes Prospective Follow-up Registry (DPV) of children and adolescents with the diagnosis of type 1 diabetes, researchers here examined the frequency of diabetic ketoacidosis in children and adolescents at diagnosis of type 1 diabetes in Germany during the first 2 months of the COVID-19 pandemic. Using multivariable logistic regression, adjusting for age, gender, and immigrant background (defined as patient or at least 1 parent born outside Germany), they compared the frequencies of diabetic ketoacidosis and severe diabetic ketoacidosis observed during the COVID-19 period vs the same periods in 2018 and 2019. Among 532 assessed children and adolescents with newly diagnosed type 1 diabetes from March 13 through May 13, 2020, from 216 of 217 diabetes centers, 238 (44.7%) presented with diabetic ketoacidosis and 103 (19.4%) presented with severe ketoacidosis. Observations suggest that during the COVID-19 pandemic in Germany, there was a significant rise in diabetic ketoacidosis and severe ketoacidosis at diabetes diagnosis in children and adolescents. Underlying etiologies may be multifactorial and indicate decreased medical services, fear of approaching the health care system, and more complex psychosocial factors.