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During the coronavirus disease 2019 (COVID-19) pandemic, a significantly lower rate of health care use has been reported, potentially leading to delayed medical care.1 Diabetic ketoacidosis is an acute life-threatening complication of a delayed diagnosis of type 1 diabetes.2 We investigated 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.
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Corresponding Author: Clemens Kamrath, MD, Center of Child and Adolescent Medicine, Justus Liebig University, Feulgenstr 12, 35385 Giessen, Germany (email@example.com).
Accepted for Publication: July 8, 2020.
Published Online: July 20, 2020. doi:10.1001/jama.2020.13445
Author Contributions: Dr Holl had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Kamrath and Mönkemöller contributed equally to this work.
Concept and design: Kamrath, Mönkemöller, Holl.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Kamrath, Holl.
Critical revision of the manuscript for important intellectual content: Mönkemöller, Biester, Rohrer, Warncke, Hammersen, Holl.
Statistical analysis: Kamrath, Holl.
Supervision: Kamrath, Biester, Warncke, Holl.
Conflict of Interest Disclosures: Dr Mönkemöller reported receiving personal fees from Medtronic outside the submitted work. Dr Biester reported receiving personal fees from Medtronic, Sanofi, Ypsomed, Novo Nordisk, AstraZeneca, DexCom, and Roche outside the submitted work. No other disclosures were reported.
Funding/Support: The German Diabetes Prospective Follow-up Registry (DPV) is supported through the German Federal Ministry for Education and Research within the German Center for Diabetes Research (DZD, grant 82DZD14A02). Further financial support was received by the German Robert Koch Institute (RKI, diabetes surveillance) and the German Diabetes Association (DDG).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Katharina Fink (Institute of Epidemiology and Medical Biometry [ZIBMT], Ulm University, Ulm, Germany), Klemens Raile, MD, PhD (Department of Pediatric Endocrinology and Diabetology, Charité, University Medicine Berlin, Germany), and Angeliki Pappa, MD (Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany), for their contribution to this work for methodology (Ms Fink), data analysis (Ms Fink), data collection (Drs Raile and Pappa), scientific discussion of the results (Ms Fink and Drs Raile and Pappa), and editing of the manuscript (Ms Fink and Drs Raile and Pappa). Andreas Hungele and Ramona Ranz developed the DPV software, Esther Bollow aggregated the DPV data, and Alexander Eckert, MSc, helped with the analysis (all clinical data managers, Ulm University). We thank Marianne Rohrer (Homburg) for language editing. None of the persons named received compensation for their contributions. We thank all centers participating in the DPV initiative (a list is available at www.d-p-v.eu).
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