COVID-19 Poses Significant Risks to Children With Poorly Controlled T1D

Pediatric patients with poorly controlled type 1 diabetes (T1D) have a 10 times greater risk of complications and death from COVID-19 compared with children whose diabetes is well controlled, according to new research. Study results will be presented at ENDO 2021, the Endocrine Society’s annual meeting, taking place from March 20-23, 2021.

Data also showed mortality rate, endotracheal tube use, and risks of pneumonia and septic shock were increased in children with T1D and COVID-19 compared with children who only had COVID-19.

Although some data have been published linking T1D in adults with higher COVID-19 risks, limited data have been made available for pediatric populations with T1D and COVID-19.

Using TriNetX, the researchers gleaned real-time electronic medical records data from 54 health care organizations. Approximately 2000 children (aged 0 months-18 years) with T1D and COVID-19 and more than 300,000 children with COVID-19 without diabetes were included in the study.

Poor diabetes was defined as glycated hemoglobin (A1C) levels higher than 9%, while A1C at 7% or less was considered well-controlled diabetes. Data showed that among children with A1C levels higher than 9%, the risk of COVID-19 complications was 10 times higher compared with those with A1C under 7%. Relative risk of mortality for children with COVID-19 and T1D was 6.05 (P < .0001).

Additional findings included:

• Mortality rate was 0.618% and 0.102% in children with COVID-19 and T1D vs children with COVID-19 and no T1D, respectively
• Endotracheal intubation rate was 0.618% and 0.071%, respectively
• Pneumonia rate was 0.804% vs 0.562%, respectively
• Relative risk of pneumonia for children with COVID-19 and T1D was 1.43 (P < .1959)
• Septic shock rate was 1.05% vs 0.293%, respectively
• Relative risk of septic shock for children with COVID-19 and T1D was 3.59 (P < .00001)

"This study shows keeping diabetic children's blood sugar under control is more important than ever during the pandemic," said author Manish Raisingani, MD. "The findings 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."

Future studies with larger sample sizes are warranted to better understand the complication rates of COVID-19 and T1D in this population.

“Many parents of children with T1D are wondering if it's safe to send their child to school during the pandemic," Raisingani continued. "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.”

Reference

Raisingani MG. Risk of complications in children with type 1 diabetes and COVID-19. Presented at ENDO 2021; March 20-23, 2021. Abstract OR23-3.