medwireNews: UK researchers have identified an increase in the number of childhood cases of new-onset type 1 diabetes during the COVID-19 pandemic, raising the possibility of a link with SARS-CoV-2 infection.
Karen Logan, from Imperial College London, and co-workers say that 30 children aged 23 months to 16.8 years presented with new-onset type 1 diabetes to one of five North West London inpatient units between 23 March and 4 June 2020.
There was a clustering of 10 diabetes cases each at two of the units, compared with two to four cases in April and May of the previous 5 years, whereas the three remaining units continued to have a more typical rate of presentations.
“In comparison with a typical year, we estimate this represents an additional 12–15 new type 1 diabetes cases (80% increase) during the COVID-19 pandemic”, the team writes in Diabetes Care.
Overall, 70% of the children presented to hospital with diabetic ketoacidosis (DKA), 52% of whom had severe DKA, defined as a pH range of 6.82–7.05. Twelve children presented with clinical shock and four were admitted to a paediatric intensive care unit, while two children had reduced consciousness, one of whom required hyperosmolar therapy.
Twenty-one children underwent nasopharyngeal swabs for SARS-CoV-2 and 16 children were tested for serum IgG antibodies, with two and three of these patients positive for the infection, respectively. But the researchers admit that testing was not universal and the timing of testing may not have allowed for IgG antibody development after infection.
Of the five children with a positive SARS-CoV-2 test, three had severe DKA and refractory hypokalaemia, including one patient who experienced hypokalaemia-related cardiac arrest but recovered after a day of ventilation.
“Only three children with known type 1 diabetes presented with DKA during the same time period”, Logan et al remark. They note that delayed presentation of type 1 diabetes has been suggested as a DKA risk factor but this did not appear to be the case in the current new-onset cohort, the majority of whom had a “relatively short symptom duration”.
The authors explain that the angiotensin converting enzyme 2 receptor, which binds the SARS-CoV-1 and -2 viruses, is “strongly expressed in pancreatic endocrine cells”, and the SARS-CoV-1 virus has previously been linked to beta-cell damage and new-onset transient diabetes.
“While our data does not prove a link, we postulate that SARS-CoV-2 exposure contributed to the observed increase in cases by precipitating or accelerating type 1 diabetes onset”, they write, citing earlier similar reports from Italy and China.
The authors conclude: “Further studies are required to establish a definitive link and any possible impact on the severity of type 1 diabetes presentation, including severe hypokalemia.”
By Lynda Williams
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Diabetes Care 2020; doi:10.2337/dc20-1551