COVID-19 among Italian children and adolescents with type 1 diabetes (T1D)

ABSTRACT

Introduction: On February 202,020, so-called Italian Patient 1 was admitted to the ICU of his local hospital due to a deteriorating clinical condition from SARS-CoV-2/COVID-19 infection. As of June 26th, 239,961 COVID-19 cases have been confirmed in Italy (children = 3805), including deaths (n = 34,708) and who have recovered (n = 187,615). Although children are generally less prone to COVID- 19 and have a milder disease course, children with existing comorbidities could remain at higher risk of complications. Objective: Aim of this study is to document clinical characteristics of children and adolescents with T1D affected with COVID-19. Methods: Starting from the week after lockdown was initiated (March 9th), ISPED started a weekly surveillance for COVID-19 infection on all children with diabetes. Cases with suspected symptoms (n = 1) or children living with positive tested relatives (n = 7), or because hospitalized (n = 3) were undergone to swab test. The surveillance is still ongoing. Results: Eleven patients were diagnosed with COVID-19 (range 6-17 years of age, 7 females);two at T1D onset and nine in patients with established diabetes (diabetes for 1-11 years), all of whom were asymptomatic (n = 7) or had only mild symptoms (n = 4). All had nasopharyngeal swabs positive for SARS-CoV-2 by RT-PCR. Three had mild hyperglycemia, 1 had mild DKA and 2 were admitted for T1D onset, 1 with DKA and 1 without. The remnant children had no disglycemia. Conclusions: In Italy, overall 11 children with T1D had laboratory COVID-19 confirmation. These patients were tested due to having mild COVID-19 symptoms or because they lived close to a known positive patient. These data seem to support the hypothesis that children with T1D are not at higher risk for COVID-19 than general population and have a mild disease course. As the pandemic continues, further work is necessary to assess how this disease affects children and to develop best-evidence-based guidelines for our vulnerable patients.