With the ongoing pandemic, new research continues to emerge about the symptoms and impact COVID-19 is having on infected individuals.
New research, led by clinicians at Imperial College Healthcare NHS Trust and researchers at Imperial College London, has reported multicentre regional findings from North West London (NWL). They found that at the peak of the pandemic, 30 children across NWL (aged up to 16 years) developed new-onset type 1 diabetes and diabetic ketoacidosis (DKA). Specifically, 70% of children presented with DKA, with severe DKA in over half (52%). Twelve children presented with clinical shock and four were managed in intensive care.
All children who presented with symptoms of COVID-19, including a fever or cough, were tested for active coronavirus. Two out of the 21 children tested were positive. For a proportion of children, it was possible to use antibody testing to determine previous infection. Sixteen children were tested and three were positive. However, as antibody testing was not routine at the time, many children were not tested for previous exposure to COVID-19.
Rebecca Unsworth, joint first author of the study, stated:
“During the peak of the pandemic widespread access to testing wasn’t available so we may have missed further cases of COVID-19 in these children who have new-onset type 1 diabetes.”
Previous reports from China and Italy have described a number of children presenting with new-onset type 1 diabetes or severe DKA during the COVID-19 pandemic, apparently unrelated to infection. This prompted concern of delayed presentation. The team from Imperial, however, believe that a number of these cases may be attributed to prior SARS-CoV-2 exposure. They hypothesise that the virus enters via the ACE2 receptor on pancreatic islet cells. They suggest that this results in β-damage and new-onset (mainly transient) diabetes.
Karen Logan, supervising author of the study, stated:
“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.”
Although the data does not prove a direct link, the team believe this increase in cases is due to SARS-CoV-2. Further research is required to establish a definitive link and determine the impact on severity of type 1 diabetes presentation.