Diabetic ketoacidosis drives COVID-19 related hospitalizations in children with type 1 diabetes

Guy Todd Alonso,Osagie Ebekozien,Mary Pat Gallagher,Saketh Rompicherla,Sarah K. Lyons,Abha Choudhary,Shideh Majidi,Catherina T. Pinnaro,Sadana Balachandar,Mariam Gangat,Alissa Jeanne Curda Roberts,Brynn E. Marks,Ana Creo,Janine Sanchez,Tossaporn Seeherunvong,Jose Jimenez-Vega,Neha S. Patel,Jamie R. Wood,Liana Gabriel,Kathryn M. Sumpter,Meredith Wilkes,Robert Rapaport,Anna Cymbaluk,Jenise C. Wong,Srinath Sanda,Anastasia Albanese-O’neill

First published: 14 April 2021 https://doi.org/10.1111/1753-0407.13184
Citations: 1
Funding information: Abbott Diabetes; Dexcom; Eli Lilly and Company; Insulet Corporation; JDRF; Leona M. and Harry B. Helmsley Charitable Trust; Medtronic; Tandem Diabetes Care

Abstract

Background
Diabetes is a risk factor for poor COVID-19 outcomes, but pediatric patients with type 1 diabetes are poorly represented in current studies.

Methods
T1D Exchange coordinated a US type 1 diabetes COVID-19 registry. Forty-six diabetes centers submitted pediatric cases for patients with laboratory confirmed COVID-19. Associations between clinical factors and hospitalization were tested with Fisher’s Exact Test. Logistic regression was used to calculate odds ratios for hospitalization.

Results
Data from 266 patients with previously established type 1 diabetes aged <19 years with COVID-19 were reported. Diabetic ketoacidosis (DKA) was the most common adverse outcome (n = 44, 72% of hospitalized patients). There were four hospitalizations for severe hypoglycemia, three hospitalizations requiring respiratory support (one of whom was intubated and mechanically ventilated), one case of multisystem inflammatory syndrome in children, and 10 patients who were hospitalized for reasons unrelated to COVID-19 or diabetes. Hospitalized patients (n = 61) were more likely than nonhospitalized patients (n = 205) to have minority race/ethnicity (67% vs 39%, P < 0.001), public insurance (64% vs 41%, P < 0.001), higher A1c (11% [97 mmol/mol] vs 8.2% [66 mmol/mol], P < 0.001), and lower insulin pump and lower continuous glucose monitoring use (26% vs 54%, P < 0.001; 39% vs 75%, P < 0.001). Age and gender were not associated with risk of hospitalization. Higher A1c was significantly associated with hospitalization, with an odds ratio of 1.56 (1.34-1.84) after adjusting for age, gender, insurance, and race/ethnicity.

Conclusions
Higher A1c remained the only predictor for hospitalization with COVID-19. Diabetic ketoacidosis is the primary concern among this group.

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