Coronavirus may be linked to onset of type 1 diabetes in children, study says lookout for warning signs
The research team recommends a larger analysis to establish a definitive link between Covid-19 and new-onset type 1 diabetes, and if so whether coronavirus has any impact on the disease's severity
There could be a link between Covid-19 and the onset of type 1 diabetes in children, suggest researchers in a new study after they found some hospitals recording nearly double the number of young patients with this condition compared to normal. The team, led by clinicians at Imperial College Healthcare NHS Trust and researchers at Imperial College London, says that the study is the first to find a possible link between Covid-19 and new-onset type 1 diabetes in children, and recommends that doctors should be on the lookout for warning signs.
"Our analysis shows that during the peak of the pandemic the number of new cases of type 1 diabetes in children was unusually high in two of the hospitals in north-west London compared to previous years, and when we investigated further, some of these children had active coronavirus or had previously been exposed to the virus. We believe this study is the first to show a potential link between Covid-19 and the development of type 1 diabetes in some children," writes Karen Logan, Honorary Research Associate at Imperial College London and Clinical Nurse Specialist at Imperial College Healthcare NHS Trust, in the report published in Diabetes Care.
Logan, who is the supervising author, adds: "Our study was limited to one UK region, and more research is needed to establish whether there is a definitive link between the two, but in the meantime, we hope clinicians will be mindful of this potential link."
Type 1 diabetes is a disease that causes insulin-producing cells in the pancreas to be destroyed, preventing the body from being able to produce enough insulin to adequately regulate blood glucose levels. If blood glucose is persistently too high, it can lead to complications such as damage to the eyes, feet and kidneys. It is often diagnosed in children but the condition can develop in young adults. Type 1 diabetes can be treated with several daily injections of insulin or using an insulin pump to keep blood glucose levels under control, say experts.
Rebecca Unsworth, joint first author from the Imperial College London, cautions that children can become very unwell if type 1 diabetes is not recognized and treated early. "It is always important to be aware of early symptoms of type 1 diabetes and look out for the four Ts, so that we can potentially diagnose and treat the condition at an earlier stage. The four Ts are feeling thirsty, going to the toilet (passing urine) frequently, feeling tired and looking thinner (weight loss)," she adds.
What did researchers find?
The authors examined data from children based in five pediatric inpatient units from four north-west London Trusts: Imperial College Healthcare NHS Trust, Chelsea & Westminster NHS Foundation Trust, The Hillingdon Hospitals NHS Foundation Trust and London North West University Healthcare NHS Trust, between March 23 and June 4.
They found an increase of children diagnosed with type 1 diabetes in two of the units, with 10 cases each. This is an increase from two and four cases respectively, for April/May combined in the previous five years. However, rates in the other three units were similar to previous years. "Thirty children (23 months to 16.8 years) in hospitals across north-west London presented with new-onset type 1 diabetes during the peak of the pandemic, approximately double the number of cases typically seen in this period in previous years, with clusters of cases in two of these hospitals," the findings state.
Any child admitted with coronavirus symptoms, including fever or cough, was tested for active coronavirus. According to researchers, 21 children were tested for Covid-19 or had antibody tests to see whether they had previously been exposed to the virus. However, antibody testing was not routine and 14 children were not tested for previous exposure to Covid-19. A total of five children with newly diagnosed diabetes had evidence of past or current coronavirus infection.
The report shows that 70% (21 out of 30) of the children with new-onset diabetes in the study presented with Diabetic Ketoacidosis (DKA). DKA is a serious condition that can happen to people with diabetes if their body starts to run out of insulin. When this happens, harmful substances called ketones build up in the body, which can be life-threatening if it's not found and treated quickly. "About 52% (11 out of 21) of the children had severe DKA. This is a much higher rate than they one would normally expect to see, and many children were very unwell," say authors.
More studies needed
The findings do not prove a direct link. However, the team argues that the fact that there was a significant rise in cases at the peak of the pandemic suggests that it is plausible that there could be a link between some cases of new-onset diabetes in children and Covid-19. The authors recommend a larger analysis to establish whether there is a definitive link between Covid-19 and new-onset type 1 diabetes, and if so whether coronavirus has any impact on the severity of the disease.
Commenting on the findings, Paul Hunter, a professor in medicine at the University of East Anglia, who was not involved in the study, emphasizes that the paper raises a concern that needs further studies to either confirm or refute its observations. "The epidemiological evidence presented in this paper is weak and cannot be used as evidence of proof of association. Nevertheless, this is an association that does need further analysis. Any association between diabetic ketoacidosis and Covid-19 may simply represent the association between ketoacidosis and any infection or may represent something particular to Covid-19. It is important that this observation is followed up," suggests Hunter.
Professors Paul Zimmet from Monash University and Francesco Rubino from King's College London, co-principal Investigators of the global registry of Covid-19-related diabetes (CoviDIAB Registry), write that early in the course of the pandemic, health experts had become aware of similar reports of new cases of both type 1 and type 2 diabetes as well as other atypical diabetes manifestations in people with Covid-19.
"All studies on the subject so far are limited by generally small sample sizes and by the fact that a diagnosis of Covid-19 could not be confirmed in all suspected cases, two issues that also apply to the new Imperial study. This is inevitable due to the short duration of human contact with the new coronavirus and the low accuracy of Covid-19 testing in the early phases of the pandemic," they explain.
Experts, however, say that they agree with the authors of the latest study that it is extremely important to improve the understanding of the relationship between Covid-19 and diabetes as the world faces inevitable new outbreaks of coronavirus in the next few months. "For this reason, we call on the international medical community to lodge information on Covid-19-related diabetes on the Registry to help understand how coronavirus-related diabetes develops, its natural history, and appropriate management. This knowledge will inform clinical practices and public health strategies during this pandemic and beyond," recommend Zimmet and Rubino.