Children with poorly controlled type 1 diabetes (T1D) who develop COVID-19 are at a much higher risk for complications of the infection — including death — compared with those whose diabetes is well controlled, according to new research presented at the Endocrine Society’s annual meeting in March 2021. A summary of the study was published on the website of the American Journal of Managed Care.
Researchers looked at real-time electronic medical records from 54 healthcare organizations, which included about 2,000 children (ages 0 to 18) with type 1 diabetes and COVID-19, and about 300,000 children without diabetes who had COVID-19. They defined poorly controlled diabetes as as A1C level (a measure of long-term blood glucose control) above 9%, while A1c below 7% was defined as well-controlled diabetes. Based on outcomes related to COVID-19 that were included in the medical records, the researchers found that the overall rate of complications from the infection was about ten times as high in children with poorly controlled diabetes compared with those whose diabetes was well controlled.
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While the overall rate of COVID-19 complications was low in both groups, children with poorly controlled diabetes were far likelier to experience a range of unwanted outcomes. The mortality rate was 0.618% in the poorly controlled group and 0.102% in the well-controlled group — indicating that children with poorly controlled diabetes were more than six times as likely to die if they developed COVID-19. The rate of endotracheal intubation (requiring a breathing tube) was 0.618% in the poorly controlled group and 0.071% in the well-controlled group, indicating about 8.7 times the need for breathing assistance. And the rate of septic shock — a very serious complication in which blood pressure drops to a dangerously low level — was 1.05% in the poorly controlled group and 0.293% in the well-controlled group, indicating about 3.6 times the risk in children with poorly controlled diabetes.
A less drastic but still concerning finding was that poorly controlled diabetes also raised the risk of pneumonia, with a rate of 0.804% compared with 0.562% in the well-controlled group, or about 1.4 times the risk. Pneumonia, in which inflamed air sacs in the lungs fill up with fluid, can be a direct consequence of COVID-19 as the respiratory infection involves the lungs.
“This study shows keeping diabetic children’s blood sugar under control is more important than ever during the pandemic,” said study author Manish Raisingani, MD, in the published summary. The results, he hopes, “will help children with T1D and their families make better choices about the safety of attending school in person and engaging in other in-person activities during this pandemic… Our findings indicate that if their A1C is high, it would be best to have them attend virtual school, but if it’s 7% or under, their risk is similar to other children without T1D.”
While the results of this study are compelling, the researchers note that larger studies are needed to get a full picture of the rates of COVID-19 complications in different groups of children with type 1 diabetes.
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