A Sudden Increase in Children with Newly Diagnosed Type 1 Diabetes Mellitus T1dm during the Peak of the Covid-19 Pandemic - Is There an Association?

ABSTRACT

Aims To assess if there is any temporal association between the sudden high incidence of newly diagnosed Type 1 Diabetes Mellitus (T1DM) in children and the onset of Coronavirus Disease 2019 (CoviD19) in Harlow, Essex UK. Methods Design An observational study Setting Princess Alexandra Hospital NHS Trust (PAH), District General Hospital Over a period of 6 weeks between end April to start of June 2020, there were 10 cases of new onset T1DM who presented to our paediatric department. We reviewed the demographics, symptomatology and biochemical presentations of these patients (table 1). Bloods including SARS-CoV-2 IgG antibody were taken at first presentation and patients had nasal swabs for SARS-COV-2 PCR. Families of patients provided written consent to take part in the project. Antibody testing with HSL Roche kit (sensitivity of 97% at D14-21 and 100% at D40) was processed at PAH microbiology laboratory. All data collators had updated training in Good Clinical Practice GCP and Consenting in paediatric e-learning modules on NIHR Learning Management Systems platform. Primary outcomes assessed the association of new onset T1DM with COVID-19 IgG positivity. Secondary outcomes assessed the degree of severity of T1DM at presentation through severity of acidosis and level of HbA1c. Clinical presentations were evaluated to assess any patterns through the cases. We also aimed to check for any demographic similarities. We derived interquartile ranges (IQR = Q3-Q1) between Q1 25% to Q3 75% to adjust for outliers in the dataset Results Only one case was detected to have IgG antibodies at the time of presentation (not in DKA). Median age of presentation was 9.5 years. The youngest being 11 months and oldest, 14 years. There were 7 males, and 3 females in the cohort. 50% of cases were not in DKA. Of those who presented with ketosis, 2 were in severe DKA (most severe at pH 6.94). None needed intensive care management. Median HbA1c at presentation was 123.5 mmol/mol. Median duration of symptoms was 23.8 days, with those not in DKA presenting on average 17 days and those in DKA (20%) presenting longer (30 days). Those in severe DKA had higher HbA1c values (143 and 151 mmol/mol). There were comorbidities of previously diagnosed autism and hypothyroidism at diagnosis of T1DM in one solitary case (not in DKA). Covid19 antibody positive patient had a history of parent succumbing to COVID-19. Demographics - 30% cases hailed from Harlow, 20% from Broxbourne and Bishops Stortford. 10% were from Waltham abbey, Waltham cross and Epping areas each. Conclusion Our small study represents an exponential rise (three-fold increase) in cases of new onset T1DM shortly following the first pandemic peak in April 2020. Only one case showed presence of past COVID-19 infection. The sampling of antibodies was limited by lack of widespread rollout of coronavirus testing at the time. Our findings support the observation that delay in diagnosis resulted in increasing patient numbers presenting in DKA. There was no association between CoVId-19 infection and new onset T1DM in children. We look forward to outcomes of larger scale studies examining this issue.