OBJECTIVE:We aimed to evaluate the diagnostic utility of the 30-minute 17-hydroxyprogesterone (17-OHP) measurement during the standard-dose Synacthen test. SUBJECTS AND METHODS:This retrospective study analyzed the medical records of patients aged 0-18 years who underwent Synacthen testing for suspected non-classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency between 2000 and 2024. RESULTS:Among 150 patients included, the median age was 13 years (range 5.5-18), and 85.3% were female. Twenty-nine patients exhibited a peak stimulated 17-OHP level ≥ 10 ng/mL. In three of these patients, the 30-minute 17-OHP level was within normal limits, whereas all had diagnostic 17-OHP levels at 60 minutes. No patients exhibited a diagnostic 17-OHP level at 30 minutes with a non-diagnostic value at 60 minutes. Using a basal 17-OHP cut-off value of 3.78 ng/mL, sensitivity and specificity were 89.7% and 94.2%, respectively. The V281L variant was the most frequently identified pathogenic variant. CONCLUSION:The 60-minute 17-OHP measurement demonstrated greater diagnostic sensitivity than the 30-minute measurement in this cohort and may provide adequate diagnostic information in pediatric patients evaluated for non-classical congenital adrenal hyperplasia, as no additional cases were identified exclusively at the 30-minute time point.

Objective:Maturity-onset diabetes of the young (MODY) is a monogenic form of diabetes characterised by early-onset diabetes and inherited in an autosomal dominant manner. MODY results from heterozygous mutations in genes important for pancreatic β-cell development or function. The objective was to identify the most common and rarest types of MODY amongst our cases with genetically confirmed MODY diagnosis, to evaluate clinical and laboratory features and treatment regimens. Methods:The epidemiological, auxological, and laboratory data, genetic analysis results and treatment regimens of patients diagnosed with MODY were retrospectively evaluated. Results:Of the 44 cases included, 27 (61.4%) were male and the median age at diagnosis was 10.07 (1-16.8) years. There was a family history of diabetes in 42 (95.5%) cases. The distribution of gene variants was: 25 (55.8%) glucokinase (GCK), 4 (9.1%) hepatocyte nuclear factor-4-alpha, 4 (9.1%) carboxyl ester lipase, 2 (4.5%) B lymphocyte kinase, 4 (9.1%) ATP-binding cassette subfamily C member 8, 2 (4.5%) Kruppel-like factor 11, 1 (2.3%) insulin (INS), 1 (2.3%) potassium channel, inwardly rectifying, subfamily J member 11, and 1 (2.3%) adaptor protein, phosphotyrosine interaction, pH domain, and leucine zipper containing 1. At presentation, 23 (52.3%) of the cases had incidental hyperglycemia while 14 (31.8%) had polyuria and polydipsia. Diabetic ketoacidosis was detected in 4 (9.1%) and ketonemia in 3 (6.9%). At least one of the diabetes autoantibodies (anti-glutamate acid decarboxylase, anti-islet cell antibodies, anti-insulin autoantibodies) was detected in 11 (25%) cases, of which 7/11 were islet antibodies, and 5 patients (11%) had two autoantibodies positive simultaneously. In terms of treatment, 26 (59%) received diet and lifestyle changes only, 18 (41%) received oral antidiabetic agents and/or insulin, and 6 (13.6%) received both oral antidiabetic agents and insulin. Conclusion:The most common type of MODY in our cohort was GCK-MODY. Although MODY is generally known as an autoantibodynegative type of diabetes, autoantibody positivity was detected in 11 of 44 cases (25%) in the present study.

Objective. This study aimed to explore the distribution, trends, and clinical characteristics of various types of childhood diabetes, including type 1 diabetes (T1DM), type 2 diabetes (T2DM), and maturity-onset diabetes of the young (MODY) in a tertiary health center. Methods. We conducted a comprehensive review of medical records of individuals aged 0–18 years who were diagnosed with diabetes between January 1996 and December 2023. Clinical and laboratory characteristics at the time of diagnosis, along with the specific diabetes type, were meticulously documented. Results. A total of 1219 patients were included in the study, of whom 48.4% were female, with a mean age at diagnosis of 9.1 ± 4.3 years. T1DM was diagnosed in 85.8% of patients, T2DM in 6.3%, clinical MODY in 5.2%, and rare forms of diabetes in 2.6%. An increasing trend in T2DM and MODY cases has been observed since 2007. Diabetic ketoacidosis (DKA) was most prevalent in T1DM (47.1%), followed by T2DM (5.2%) and MODY (1.6%). Mean C-peptide levels at diagnosis were 0.57 ± 0.5 ng/mL in T1DM, 3.2 ± 1.3 ng/mL in T2DM, and 1.4 ± 0.9 ng/mL in MODY. Antibody positivity was observed in 78.8% of T1DM, 6.5% of T2DM, and 15.9% of MODY cases. Among the MODY group, genetic analysis was performed in 48 (75%) patients, with GCK gene mutations identified as the most common genetic abnormality in 27 (56.2%) of these patients. Conclusion. This study demonstrates that T1DM is still the most commonly diagnosed type of diabetes in childhood, while T2DM and MODY are less frequent. However, a temporal increase in the incidence of MODY and T2DM subtypes was observed. The incidence of DKA at diagnosis was significantly higher in T1DM patients compared with those diagnosed with MODY or T2DM.

17α Hydroxylase/17,20 lyase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia, typically diagnosed in late adolescence with symptoms of pubertal delay and hypertension. This study aimed to determine the clinical and laboratory characteristics of 17OHD cases and gather data on disease management. Data from 97 nationwide cases were analyzed using the CEDD-NET web system. Diagnostic, follow-up findings, and final heights of patients were evaluated. Mean age at admission was 13.54 ± 4.71 years, with delayed puberty as the most common complaint. Hypertension was detected in 65

OBJECTIVE:This study aimed to determine the response to growth hormone (GH) therapy of patients with growth hormone deficiency (GHD), idiopathic short stature (ISS), and small for gestational age (SGA). MATERIALS AND METHODS:The data of the 202 children who received GH treatment were analyzed retrospectively. Laboratory parameters, puberty stages, annual growth rates, body mass index (BMI), GH side effects, target height (TH), estimated adult height (EAH), and bone age (BA) were obtained during the GH treatment period. RESULTS:Out of 202 cases, 121 were girls (59.9%) and 81 were boys. Among these cases, 69 (34.1%) had partial growth hormone deficiency (PGHD), 43 (21.2%) had complete growth hormone deficiency (CGHD), 37 (18.3%) had ISS, and 53 (26.2%) were born SGA. The average age at the onset of treatment was 11.2±2.67 years. The height standard deviation score (SDS), height velocity, and predicted adult height (PAH) of the patients with PGHD, CGHD, and SGA values were significantly higher than ISS patients at the end of the third year of a similar dose of GH treatment. The highest growth velocity was determined in the group with CGHD, while the lowest height velocity was found in patients with ISS during three years of the treatment. CONCLUSION:It was determined that GH treatment is an efficient and reliable therapy method for improving short stature in patients with PGHD, CGHD, ISS, and SGA. We observed a higher growth rate in patients with PGHD, CGHD, and SGA than in the ISS group with standard dose GH treatment.

Introduction:Although more common in adults, autoimmune thyroiditis (AT) is one of the most common thyroid diseases in children and adolescents.Salivary gland involvement has been described in many studies of patients with AT.Several inflammatory scores are used to assess the inflammatory status of patients with systemic autoimmune diseases.We aimed to sonographically evaluate the parotid and submandibular salivary glands with inflammatory parameters in patients with AT in our study.Methods: Our study population consisted of 37 consecutive pediatric AT patients and 29 healthy control subjects.Ultrasonographic and laboratory evaluations of the study population were performed.Jamovi and MedCalc software were used to analyze the data.Results: The volume of the thyroid gland in the patients was significantly higher than that in the control group (p=0.030),while there was no difference in the volume of the salivary glands.Multiple logistic regression analysis was planned to assess the predictability of salivary gland involvement in patients with the disease.Both systemic immune-inflammation index (SII) and pan-immune inflammation value (PIV) were found to be predictors of salivary gland involvement in AT patients. Conclusion:We found that both SII and PIV inflammatory markers are predictive of salivary gland parenchymal changes in patients with AT, and SII is likely to be more valuable than PIV at this time.

OBJECTIVE:Since Cushing's disease (CD) is less common in the paediatric age group than in adults, data on this subject are relatively limited in children. Herein, we aim to share the clinical, diagnostic and therapeutic features of paediatric CD cases.DESIGN:National, multicenter and retrospective study.PATIENTS:All centres were asked to complete a form including questions regarding initial complaints, physical examination findings, diagnostic tests, treatment modalities and follow-up data of the children with CD between December 2015 and March 2017.MEASUREMENTS:Diagnostic tests of CD and tumour size.RESULTS:Thirty-four patients (M:F = 16:18) from 15 tertiary centres were enroled. The most frequent complaint and physical examination finding were rapid weight gain, and round face with plethora, respectively. Late-night serum cortisol level was the most sensitive test for the diagnosis of hypercortisolism and morning adrenocorticotropic hormone (ACTH) level to demonstrate the pituitary origin (100% and 96.8%, respectively). Adenoma was detected on magnetic resonance imaging (MRI) in 70.5% of the patients. Transsphenoidal adenomectomy (TSA) was the most preferred treatment (78.1%). At follow-up, 6 (24%) of the patients who underwent TSA were reoperated due to recurrence or surgical failure.CONCLUSIONS:Herein, national data of the clinical experience on paediatric CD have been presented. Our findings highlight that presenting complaints may be subtle in children, the sensitivities of the diagnostic tests are very variable and require a careful interpretation, and MRI fails to detect adenoma in approximately one-third of cases. Finally, clinicians should be aware of the recurrence of the disease during the follow-up after surgery.

Distal renal tubular acidosis (dRTA) may rarely occur in the course of autoimmune diseases. We present a patient who was followed up with Graves' disease and vitiligo and who was diagnosed with dRTA upon detection of hypopotasemia. A 9.2-year-old girl presented with complaints of sweating, palpitations, and hand tremors. The patient had vitiligo on examination and was diagnosed with Graves' disease per clinical and laboratory findings. The patient, who received methimazole and was followed up as a euthyroid, was found to have hypokalemia in biochemical examinations performed at the age of 13 years. While investigating the etiology of hypokalemia, the patient was diagnosed with dRTA. Since she had two autoimmune pathologies, it was thought that the dRTA might be of autoimmune origin. Checking serum potassium levels in the follow-up of patients with Graves' disease may allow early diagnosis and treatment of accompanying dRTA.

Context: 17α-Hydroxylase/17,20-lyase deficiency (17OHD) is characterized by decreased sex steroids and cortisol synthesis, as well as an increased mineralocorticoid effect. Aim: This study aimed to evaluate the clinical, biochemical, and molecular characteristics of patients with 17OHD and to discuss the diagnosis, treatment, and follow-up process. Methods: Age, symptoms, anthropometric measurements, blood pressure, and hormonal, biochemical, and chromosomal analysis results of 13 patients diagnosed with 17OHD between 2003 and 2022 were recorded at admission and during follow-up. Whole gene next-generation sequencing was performed for the CYP17A1 gene. Multiplex ligation-dependent probe amplification was used to detect deletions in patients without point mutations in CYP17A1. Results: The median age at diagnosis was 14.0 (3.5–16.8) years. Nine of 13 patients (69.2%) had 46,XY karyotypes. All patients were phenotypically female and were raised as girls. The most common reasons for admission were the absence of puberty and amenorrhea (n = 8, 61.5%), followed by hypertension (n = 3, 23.0%), and family screening (n = 2, 15.3%). At the time of diagnosis, hypertension was detected in 10 (76.9%) patients, and 11 (84.6%) patients had hypokalemia. Conclusions: 17OHD should be considered in patients with pubertal delay/primary amenorrhea, hypertension, and hypokalemia. Adrenal function should be included in the clinical study of hypergonadotropic hypogonadism, after excluding Turner syndrome, in all 46,XX females. Deletion in the CYP17A1 gene, including exons 1–6, is the founder mutation for Turkey’s east and southeast regions.

BACKGROUND:The increasing prevalence of childhood obesity and accompanying comorbidities all over the world constitutes one of the most important public health problems of the changing world. The frequency and causes of the metabolically healthy obesity (MHO) phenotype in children is not clear. OBJECTIVE:The objective is to determine the prevalence of the MHO phenotype in obese Turkish children and adolescents and to identify clinical and biochemical indicators for this phenotype. METHODS:Eight hundred forty-seven obese children and adolescents, aged 3-18 years with BMI-SDS >+2 SD from the obesity outpatient clinic were included. Demographic, anthropometric, and physical examination information was collected from patient medical files. In addition, obesity-related comorbidities and results of laboratory tests were obtained. For study purposes, obese patients with no cardiometabolic risk factors were accepted as MHO, and those with ≥1 cardiometabolic risk factor were considered metabolically unhealthy obese (MUO). MHO was defined according to Damanhoury's criteria. RESULTS:Out of 847 children (mean age 10.6±3.4 years) who met the study criteria, 289 (34.1%) were diagnosed with MHO. Being younger, prepubertal, having relatively low BMI, low waist/hip ratio, low insulin resistance (HOMA-IR) index, high high-density lipoprotein, low triglyceride, low fasting insulin and glucose levels, low uric acid and low alanine transaminase (ALT) levels were associated with MHO. CONCLUSIONS:The MHO phenotype was present in just over a third of this obese pediatric cohort. The most important factors associated with MHO; age, waist-hip ratio, and BMI were determined.

Objective:With the diagnosis of chronic illness in children, a stressful period is likely to begin for both the affected child and their families. The aim of this study was to investigate the factors affecting chronic disease management by the parents of children diagnosed with type 1 diabetes mellitus (T1DM).Methods:The sample consisted of 110 children, aged between 4-17 years and their mothers. The patients had been diagnosed with T1DM for at least one year, and had attended pediatric endocrinology outpatients or were hospitalized in a single center. First, sociodemographic information about the child with T1DM were obtained. Then, the “Family Management Measure” (FaMM) was applied. The FaMM is constructed to measure family functioning and management in families who have a child with a chronic illness.Results:Paternal years of education (p=0.036), family income (p=0.008), insulin pump use (p=0.011), and time elapsed after diagnosis (p=0.048) positively affected both the management of T1DM and the child’s daily life. However, presence of chronic diseases in addition to T1DM (p=0.004) negatively affected diabetes management. Higher maternal education year (p=0.013) and family income level (p=0.001) increased parental mutuality scores. However, as the time after diagnosis increased, parental mutuality scores decreased.Conclusion:It is important to evaluate the child with chronic disease with a biopsychosocial approach. This approach aims to evaluate the problems of the child and his/her family who experience the disease with a holistic approach.

Objective: Idiopathic hypogonadotropic hypogonadism (IHH) is classified into two groups-Kalman syndrome and normosmic IHH (nIHH).Half of all cases can be explained by mutations in >50 genes.Targeted gene panel testing with nexrt generation sequencing (NGS) is required for patients without typical phenotypic findings.The aim was to determine the genetic etiologies of patients with IHH using NGS, including 54 IHH-associated genes, and to present protein homology modeling and protein stability analyzes of the detected variations.Methods: Clinical and demographic data of 16 patients (eight female), aged between 11.6-17.8years, from different families were assessed.All patients were followed up for a diagnosis of nIHH, had normal cranial imaging, were without anterior pituitary hormone deficiency other than gonadotropins, had no sex chromosome anomaly, had no additional disease, and underwent genetic analysis with NGS between the years 2008-2021.Rare variants were classified according to the variant interpretation framework of the American College of Medical Genetics and Genomics (ACMG)/Association for Molecular Pathology.Changes in protein structure caused by variations were modeled using RoseTTAFold and changes in protein stability resulting from variation were analyzed.Results: Half of the 16 had no detectable variation.Three (18.75%) had a homozygous (pathogenic) variant in the GNRHR gene, one (6.25%)had a compound heterozygous [likely pathogenic-variants of uncertain significance (VUS)] variant in PROK2 and four (25%) each had a heterozygous (VUS) variant in HESX1, FGF8, FLRT3 and DMXL2.Protein models showed that variants interpreted as VUS according to ACMG could account for the clinical IHH. Conclusion:The frequency of variation detection was similar to the literature.Modelling showed that the variant in five different genes, interpreted as VUS according to ACMG, could explain the clinical IHH.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

OBJECTIVE:The aim was to analyze the incidence trend and annual average incidence change of type 1 diabetes (T1DM) in the population <18 years of age in Malatya province.MATERIALS AND METHODS:Medical files of patients followed up with T1DM in pediatric endocri- nology clinics were reviewed. The data for the child census was taken from the Turkish Statistical Institute (TUIK), and T1DM incidence was analyzed according to the calendar year, gender, and age groups. Recently diagnosed T1DM patients per 100 000 children per year were calculated. In addition, the trend in annual incidence change over the period 2007-2019 was analyzed.RESULTS:The mean incidence of T1DM during the 13 years was 13.1/105 child years (13.8/105 child years for girls and 12.4/105 child years for boys). During the 13-year follow-up period, a sig- nificant increasing trend in the incidence of T1DM was detected. The average annual percent change (AAPC) was 8.3%. According to age groups, the average AAPC was 8.1% between 0 and 4 years old, 9.4% between 5 and 9 years old, 12.1% between 10 and 14 years old, and 30.1% between 15 and 17 years old.CONCLUSION:The incidence of T1DM in children under 18 years of age in Malatya, one of the larg- est cities in the Eastern Anatolia region of Turkey, was determined as 13.1/105 child years in the last 13 years and the average annual increase rate was 8.3%.

Amaç: Tip 1 diabetes mellitus (T1DM) tanılı çocuklar diyabet öz bakımında gözetime ihtiyaç duymaktadırlar ve günün önemli bir kısmını geçirdikleri okuldaki koşullar hastalık yönetimini etkilemektedir. Bu çalışmanın amacı, T1DM tanılı ana sınıfı ve ilkokul çağındaki çocukların okulda hastalık yönetimi ile ilgili karşılaştıkları sorunları ortaya koymaktır. Gereç ve Yöntem: Bu kesitsel çalışmaya T1DM tanılı 5-10 yaş aralığındaki 50 hasta dahil edildi. Literatür doğrultusunda araştırmacı tarafından geliştirilen okulda diyabet yönetimiyle ilgili anket, Google anket formu aracılığıyla hasta ve/veya ebeveynleri tarafından dolduruldu. Elde edilen veriler tanımlayıcı istatistiksel yöntemlerle analiz edildi. Bulgular: Hastaların ortalama diyabet süreleri 5,39±2,56 yıldı. Olguların %94’ü devlet okuluna gidiyordu. Okulların %78’inde sağlık bakım odası, %92’sinde hemşire/sağlık personeli yoktu. Olguların %86’sı okulda ana öğün alıyordu, ancak bunların büyük çoğunluğu öğününü evden getiriyor veya eve gidip yiyordu. Beslenme ile ilgili en sık sorun okulda diyete uygun olmayan gıdaların tüketilmesiydi. Çocukların %6’sında okulda kan şekeri ölçümü yapılmıyordu. Okulda hipoglisemi yaşamış olanların sıklığı %40 olup en sık müdahale eden kişi öğretmendi (%55). Okulda insülin uygulanan çocukların %77,5’inde uygulamayı anne veya baba yapıyordu. İnsülin uygulamada yaşanan en sık sorunlar okulda uygulayabilecek kişinin ve uygun ortamın olmaması idi. Beden eğitimine katılım %98’di. Çocuklar öğretmen ve okul yönetiminden yüksek oranda olumlu yaklaşım görürken, %18 çocuk,arkadaşlarının olumsuz yaklaşımına maruz kalmaktaydı. Sonuç: T1DM tanılı çocuklar okulda beslenme, kan şekeri ölçümü ve insülin uygulama konularında zorluklar yaşamaktadırlar. Okullarda sağlık bakım odası ve/veya sağlık personeli çoğunlukla bulunmamaktadır. Okulda insülin uygulama konusunda deneyimli kişi olmaması nedeniyle bunu genellikle ebeveynler yapmaktadır.

Abstract Objectives The aim of the study was to determine the prevalence of metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), and other comorbidities in overweight and obese children in Malatya, Turkey. Methods Retrospective cross-sectional study. We studied 860 obese and overweight children and adolescents (obese children Body mass index (BMI) >95th percentile, overweight children BMI >85th percentile) aged between 6 and 18 years. The diagnosis of MetS, impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and T2DM were defined according to modified the World Health Organization criteria adapted for children. Other comorbidities were studied. Results Subjects (n=860) consisted of 113 overweight and 747 obese children of whom 434 (50.5%) were girls. MetS was significantly more prevalent in obese than overweight children (43.8 vs. 2.7%, p<0.001), and in pubertal than prepubertal children (41.1 vs. 31.7%, p<0.001). Mean homeostasis model assessment for insulin ratio (HOMA-IR) was 3.6 ± 2.0 in the prepubertal and 4.9 ± 2.4 in pubertal children (p<0.001). All cases underwent oral glucose tolerance test and IGT, IFG, and T2DM were diagnosed in 124 (14.4%), 19 (2.2%), and 32 (3.7%) cases, respectively. Insulin resistance (IR) was present in 606 cases (70.5%). Conclusions Puberty and obesity are important risk factors for MetS, T2DM, and IR. The prevalence of MetS, T2DM, and other morbidities was high in the study cohort. Obese children and adolescents should be carefully screened for T2DM, insulin resistance, hyperinsulinism, dyslipidemia, hypertension, IGT, and IFG. The prevention, early recognition, and treatment of obesity are essential to avoid associated morbidities.

There is a scarcity of data concerning endocrine function and the effects of enzyme replacement therapy (ERT) on growth and other endocrine functions in patients with mucopolysaccharidosis (MPS). This study retrospectively evaluated height increase, bone mineral density (BMD), and other endocrine functions in MPS patients who received ERT for at least two years in our clinic. The clinical findings, hormonal analysis (TSH, fT4, ACTH, cortisol, FSH, LH, testosterone, estradiol, prolactin, GH, IGF-1, IGFBP-3), and BMD measurements of 10 MPS patients, aged 0-18 years, before and after ERT were recorded and compared retrospectively. Four patients were MPS Type-2, five were MPS Type-4, and one was MPS Type-6. Nine of the patients were male, and one was female. The mean treatment onset age was 7.6 years. The mean ± standard deviation of the patients' height SDS was -4.61±3.01 before treatment and -5.65±2.42 after treatment. While the mean BMD Z-score of the patients was -2.33±1.77 before treatment, it was -0.94±1.52 after treatment. Apart from growth retardation (one of the most prominent disease features), no severe dysfunction was detected in other endocrine organs in our patients with MPS. Severe short stature was evident at the time of diagnosis in MPS patients, and their height SDS worsened, despite ERT. However, osteoporotic BMD Z-scores at diagnosis improved after ERT. No serious dysfunction was seen in other endocrine organs.

Familial hypocalciuric hypercalcemia (FHH) is a benign disease associated with heterozygous inactivating mutations in the calcium-sensing receptor (CaSR) gene. This article presents a girl with heterozygous p.Cys575Tyr variation in the CaSR gene. The serum calcium level of a 9.2-year-old girl was 12.4mg/dl in incidental laboratory analysis. On the same occasion, the serum parathyroid hormone (PTH) level was 45 pg/ml, 25(OH) vitamin D level 24.2ng/ml, 1.25 dihydroxy vitamin D level 22pg/ml, and urinary Ca/creatinine ratio <0.01. The ultrasonographic evaluation of the urinary system was unremarkable. The clinical and laboratory findings pointed towards FHD. A heterozygous p.Cys575Tyr (c.1724G>A) variation was detected in the patient's CaSR gene, which was reported before, but no clinical manifestations were specified. In children with asymptomatic hypercalcemia, the diagnosis of FHH should be considered if the PTH level is normal or high and the urinary calcium is low.

Objectives: The COVID-19 pandemic is a global health problem with high morbidity and mortality. This study aimed to compare the clinical features of newly diagnosed type 1 diabetes (T1D) patients during the pandemic with those diagnosed earlier and evaluate how the pandemic affected the T1D clinical findings on admission. Methods: This is a 2-year, single-center, cross-sectional study. The time between March 11, 2019, and March 11, 2020, was defined as the “pre-pandemic period,” while the interval between March 11, 2020, and March 11, 2021, was called the “pandemic period.” The clinical and laboratory parameters of newly diagnosed T1D patients admitted in these two time periods were compared. Results:The admission rate with DKA was higher in the pandemic period than in the pre-pandemic time (71.0% and 52.8%, respectively, p=0.046). There was no difference between the groups regarding the severity of DKA. The mean duration of diabetes symptoms before diagnosis was longer during the pandemic than in the pre-pandemic period (17.0 days and 12.5 days, respectively, p=0.035). Conclusions: Delayed applications to health institutions of patients with diabetes signs and symptoms during the pandemic are worrisome. This delay is likely to have increased the DKA rate. As a result, children with diabetes symptoms should be ensured to apply to a health institution without hesitation, even in the pandemic.