Diabetes and hyperglycemia are risk factors for severe COVID-19 course and/or death in adult patients. While most cases in children remain mild, studies in pediatric T2D are limited.
Our study aim was to describe the clinical characteristics of COVID-19 course in youth with T2D. We conducted a retrospective review of electronic medical records of patients with T2D and positive SARS-CoV-2 PCR testing performed at Texas Children’s Hospital between 3/1/2020 and 10/31/2020. Demographics, diabetes treatment regimen, metrics of glycemic control, and variables of COVID-19 course were recorded and analyzed.
We identified 14 youth with active T2D and positive SARS-CoV-2 testing. All individuals had established diabetes; none were concurrently diagnosed with new onset T2D and SARS-CoV-2. Of them, 43% [n=6] were African-American, 57% [n=8] Hispanic, and none were Non-Hispanic Whites. All individuals had public medical insurance and were obese, with mean BMI Z score =+2.22 [SD =0.48]. Median last hemoglobin A1C within 3 months prior to testing positive for SARS-CoV-2 was 13.2% [IQR= 2.50%], with 27% [n=3] patients’ last A1C above the limit of detection [>14.0%] and 91% [n=10] above the American Diabetes Association Standards of Care goal of 7.0%. Twelve (85.7%) children were on insulin and 36% [n=5] on Metformin. Admission was required in 42.8% [n=6] children, 1 prior and 2 after having SARS-CoV-2 detected, and 3 at the time of SARS-CoV-2 detection for diabetic ketoacidosis [DKA]. Mean pH for those admitted for DKA [n=3] was 7.12 [SD = 0.09]. Median length of all admissions was 1.5 days [IQR = 1.23 days]. One patient required brief supplemental oxygen for comfort, but no patients had documented hypoxia. No patients required intubation and no patients expired.
In sum, T2D in youth did not appear to be a risk factor for severe SARS-CoV-2 related illness. However, prevalence of DKA was higher than expected, suggesting that COVID-19 may adversely affect diabetes course; this will require further investigation.
A. Cymbaluk: None. M. Astudillo: None. D. Desalvo: Consultant; Self; Insulet Corporation, Research Support; Self; Insulet Corporation, Speaker’s Bureau; Self; Dexcom, Inc. F. Bacha: None. S. Mckay: None. M. J. Redondo: Advisory Panel; Self; Provention Bio, Inc.