COVID-19 (coronavirus disease 2019) and type 1 diabetes: DKA risk in children

ABSTRACT

Background: In many chronic diseases, a negative influence of coronavirus disease 2019 (COVID-19) on course and prognosis has been described. Objectives: The goal is to examine the impact of COVID-19 disease on children and adults with type 1 diabetes. Materials and methods: We evaluated the published literature on the risk assessment of COVID-19 in people with type 1 diabetes and the role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the development of the disease. Results: In adults older than 50 years with type 1 or type 2 diabetes, the risk of severe disease or death from COVID-19 is significantly increased in relation to metabolic control compared with the risks in persons of the same age in the background population. In contrast, severe courses in children with type 1 diabetes have not been described. However, there is an increase of severe illness because of diabetic ketoacidosis (DKA) during the pandemic, both at manifestation and during the course of the disease. Although in humans SARS-CoV‑2 has been shown to infect islet cells, an association with increased incidence of type 1 diabetes has not been demonstrated epidemiologically to date. Conclusions: Type 1 and type 2 diabetes in older age is associated with fatal outcomes of COVID-19. Children and youth with diabetes do not have an increased risk for COVID-19 mortality. Special attention has to be given on the prevention of DKA both at type 1 diabetes onset and during long-term care. As in many other areas of health care, the COVID-19 crisis could offer the opportunity to establish a virtual diabetes clinic to complement standard outpatient care.