New data on the risks of COVID-19 in children with type 1 diabetes provide reassurance, but also emphasize the importance of effective blood glucose control.
Results from over 3000 children with type 1 diabetes and more than 500,000 without suggest that rates of mortality, intubation, and sepsis with COVID-19 were no greater in those with type 1 diabetes, as long as they had A1c levels ≤ 7%.
However, rates for those COVID-19 outcomes were significantly higher among children with type 1 diabetes and A1c levels > 9%.
These pediatric findings are similar to several previous studies in the overall and adult type 1 diabetes populations, including analyses from the UK Biobank early in the pandemic.
“It is extremely important that blood sugars are well controlled during the COVID-19 pandemic to prevent hospitalizations and death in children with type 1 diabetes,” said Manish Raisingani, MD, who presented the findings of an analysis from the large worldwide database TriNetX at the virtual ENDO 2021 meeting.
He added that the data can help inform decisions about whether it’s safe to send children with type 1 diabetes back to in-person classrooms.
“If the A1c is under 7%, you’re not likely to have significant complications from COVID-19 as long as you take precautions such as masking and social distancing…On the other hand, if the A1c is above 9%, [it’s] best to do virtual school during these times,” said Raisingani, a pediatric endocrinologist at the Arkansas Children’s Hospital, Little Rock.
Asked to comment, Robert W. Lash, MD, the Endocrine Society’s chief professional & clinical affairs officer, told Medscape Medical News that he generally agrees with Raisingani’s conclusions and advice.
However, he cautioned against focusing on the relative increased risk rather than the absolute increased risk, which was fairly small overall.
“Even one death is tragic and [one] too many, but focusing on the relative risk scares the bejesus out of people,” Lash commented.
What the data show, according to Lash, is that “If your child has diabetes and is struggling with it, school is probably not the best place for them.”
On the other hand, “If your child has diabetes and is taking good care of it, he is not a walking COVID-19 timebomb.”
A1c Matters in COVID-19 Risk in Children With Type 1 Diabetes
Raisingani and colleagues analyzed data from TriNetX, a large COVID-19 database that collects real-time electronic medical records data from 60 health care organizations worldwide.
They compared 3047 children aged 0-18 with type 1 diabetes to 502,655 children without type 1 diabetes, and also examined a subset of 482 children with type 1 diabetes and A1c ≤ 7%.
There were 235 deaths in the group without diabetes, 10 in the group with type 1 diabetes, and none in those with type 1 diabetes and A1c ≤ 7%, which translates to mortality rates of 0.047%, 0.328%, and 0, respectively.
Compared to the group without diabetes, the relative mortality risk for the overall group of kids with type 1 diabetes was 7.04 (P < .0001).
In contrast, the P value for the group with A1c ≤ 7% compared to those without diabetes was not significant (P = 0.6349).
“If you have well-controlled type 1 diabetes your risk of dying from COVID-19 is very, very low. It’s not much different from the general population,” Raisingani noted.
Similarly, for sepsis the numbers were 575, 15, and 0 for those without type 1 diabetes, all patients with type 1 diabetes, and the A1c ≤ 7% subgroup, respectively, translating to percentage risks of 0.114, 0.492, and 0.
Again, the relative risk overall with type 1 diabetes was a significant 4.3-fold higher (P < 0.0001), but was not significant for those with A1c ≤ 7% (P = .79).
Finally, endotracheal intubations were required for 142, 10, and 0 children in the nondiabetes, type 1 diabetes, and A1c ≤ 7% groups, with percentage risks of 0.028, 0.328, and 0, respectively. The relative risk for the overall type 1 diabetes group was 11.65 (P < .001).
During the discussion, Raisingani said that the same risks were seen after adjustment for factors such as age and sex, but that not all confounder information was available from all contributing centers.
Nonetheless, he noted, “As the A1c goes from 9% to 10%, the risk increases exponentially.”
Raisingani and Lash have reported no relevant financial relationships.
ENDO 2021. Abstract OR23-3. Presented March 20, 2021.
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