Severe coronavirus disease 2019 in children and young adults

DeBiasi et al report that 3% of the pediatric patients who tested positive with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at their center had a history of diabetes. Diabetes is currently listed by the Centers for Disease Control and Prevention as an underlying condition that places individuals at higher risk for severe illness. Two of the 5 patients with diabetes required hospitalization. Of the 2 patients, 1 patient with type 1 diabetes and brain injury required intensive care unit-level care. It would be informative to know the type of diabetes, duration of diagnosis, and glycemic control for those patients. Would the authors be able to provide these data, as well as whether the patients presented with symptoms related to diabetes vs symptoms related to SARS-CoV-2? Were any of the patients with SARS-CoV-2 newly diagnosed with diabetes?

At the Mount Sinai Kravis Children’s Hospital, during the height of the pandemic in New York City, 10 pediatric patients (average age, 14.5 years; 8 female; 5 with new-onset diabetes) were treated in the emergency department or hospitalized with diabetes related complications. Eight were found to be in diabetic ketoacidosis when presenting to the emergency department. Three patients tested SARS-CoV-2 positive, and 3 patients had symptoms suggestive of SARS-CoV-2 and were in contact with sick family members. Compared with the prior 3 years at our children’s hospital, no significant difference was noted in the number of patients with type 1 diabetes admitted or treated in the emergency department. There were also no significant differences in the number of newly diagnosed patients or severity of diabetic ketoacidosis.

To date, as part of the ongoing Type 1 diabetes COVID-19 Surveillance Study (www.t1dexchange.org/COVID19) coordinated by the T1D Exchange, there have been more than 20 reported cases of SARS-CoV-2 nationally in pediatric patients with type 1 diabetes.