ABSTRACT
Objective: To describe clinical manifestations of SARS-CoV-2 infection in children, adolescents, and young adults with established type 1 diabetes and explore the effects of COVID-19 on glycemic control and disease course. Method(s): Observational study conducted at three pediatric diabetes clinics in Israel between mid-March-2020 and mid- March-2021. Included were young people with established type 1 diabetes, <30years, who tested positive for SARS-CoV-2 (qRTPCR). Data was collected from medical files, diabetes devices, and COVID-19 questionnaire. Outcome measures were analyzed by presence/absence of clinical symptoms (symptomatic/asymptomatic) and by age group (pediatric, <19years/young adults, 19-30years). Result(s): Of 132 patients, mean age 16.9+/-5.3years, with COVID- 19 confirmed infection, 103 (78%) had related symptoms;the most common were headaches, fatigue, fever and loss of sense of smell. All had mild disease course, but four required hospitalization and two cases were directly related to COVID-19 infection (pleuropneumonia in a patient with immunodeficiency syndrome, one case of diabetic-ketoacidosis). Logistic regression analysis showed that age (OR=1.11, 95%CI, 1.01, 1.23;P=0.033), elevated glucose levels (OR=5.23, 95%CI, 1.12, 24.41;P=0.035) and comorbidities (OR=8.21, 95%CI, 1.00, 67.51;P=0.050) were positively associated with symptomatic infection. Persistent symptoms occurred in 16.5% of the cohort over a median of 6.7 months;age (OR=1.14, 95%CI, 1.01, 1.29;P=0.030) and elevated glucose levels (OR=3.42, 95%CI, 1.12, 10.40;P=0.031) were positively associated with persistent symptoms. Usually, no change was reported in glucose levels (64%) except for a temporary deterioration in glycemic control during the short infection period. Conclusion(s): Young people with established type 1 diabetes experience mild COVID-19 infection. Elevated glucose levels during COVID-19 infection and older age were associated with prolonged disease course.