The first published study on COVID-19 outcomes in children with type 1 diabetes in the United States shows that most children had fairly good health outcomes, with no recorded deaths and most children not needing hospitalization. The new study was published in the Journal of Diabetes.
People with diabetes — including type 1 diabetes — are known to have a higher risk for poor outcomes if they develop COVID-19, including a higher risk of hospitalization and death. But the studies that led to these conclusions have been almost entirely studies of adults, leaving unanswered questions about whether children face the same degree of increased risk for poor outcomes.
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For the latest study, researchers looked at data including 266 juvenile patients (under age 19) with type 1 diabetes who developed COVID-19. The most commonly reported adverse outcome associated with COVID-19 in this group was diabetic ketoacidosis (a serious condition marked by high glucose and high levels of chemicals called ketones in the blood), which affected 44 of the participants, representing 72% of the participants who were hospitalized. There were also four hospitalizations for severe hypoglycemia (low blood glucose), as well as three hospitalizations in which children required respiratory support due to difficulty breathing. Another 10 participants were hospitalized for reasons that appeared to be unconnected to diabetes or COVID-19. The 61 total hospitalized patients were more likely than the 205 who weren’t hospitalized to identify as members of a minority racial or ethnic group (67% versus 39%), more likely to have a form of public health insurance (64% versus 41%), and more likely to have a higher A1C level (a measure of long-term blood glucose control) — with an average A1C level of 11% versus 8.2%. Hospitalized patients were also less likely than those who weren’t hospitalized to use an insulin pump or continuous glucose monitoring (CGM) system (26% versus 54%).
Higher A1C linked to increased risk for hospitalization
The researchers found that within the study group, age and sex were not related to the risk of hospitalization. A higher A1C level, though, was linked to a significantly higher risk of hospitalization after adjusting for age, sex, insurance status, and race and ethnicity. As noted in a Medscape article on the study, the highest risk for hospitalization was seen in children with an A1C level above 9%. When it came to symptoms related to COVID-19,hospitalized patients were more likely to have hyperglycemia (high blood glucose), which affected 48% of this group compared with 28% of other study participants. Hospitalized patients were also more likely to experience nausea (33% versus 6%) and vomiting (49% versus 3%).
The registry that these study results are based on is ongoing, so it’s possible that the results will be updated as more children with type 1 diabetes develop COVID-19. But so far, it looks like most of the worst potential outcomes of COVID-19 — including death and long-term intubation — tend to spare children with type 1 who develop the viral infection.
Want to learn more about coronavirus and diabetes? Read our latest COVID-19 updates.