Andrew Norris, MD PhD
Director, Pediatric Endocrinology & Diabetes
University of Iowa Stead Family Children’s Hospital
It has been well publicized that diabetes is a major risk factor for severe and fatal COVID-19. This is a frightening prospect for all with diabetes, but leads to questions of how this applies across ages and to type 1 versus type 2 diabetes. Some reassuring news arrived on March 25, when the International Society for Pediatric and Adolescent Diabetes published a brief, reassuring note (see this link) that front-line physicians in China and Italy had not observed severe COVID-19 in young persons with diabetes. However, specific data was not reported and the note was not peer reviewed per se. Now, a much larger and systematic study of persons with diabetes and COVID-19 has been published in the peer reviewed journal Diabetologia (link to the article). Over 1300 persons hospitalized with COVID-19 who had diabetes were studied. The study focused on the first 7 days of hospitalization for COVID-19, defining severe outcome as death and/or requiring intubation. Consistent with prior reports, severe COVID-19 was common among the patients with diabetes, with over 10% mortality by 7 days. The study found that higher BMI, older age, obstructive sleep apnea, and pre-existing vascular complications were strong predictors of severe COVID-19 in these subjects. Only 3% of the subjects had type 1 diabetes whereas 89% had type 2 diabetes. For those subjects with type 1 diabetes and younger age, the authors wrote that “our data can be considered reassuring for the majority of people living with type 1 diabetes. Indeed, there was no death in participants with type 1 diabetes younger than 65 years.” Although the study lends further reassurance that severe COVID-19 is not common among young persons with diabetes, especially type 1 diabetes, it was not suitably designed to fully answer the question. For one, there was no control population without diabetes studied. So, for example, although the risk of severe COVID-19 appeared markedly less among younger patients, this was only in reference to older patients. Another shortcoming for the purpose of understand the impact of pediatric diabetes on COVID-19 severity was that the youngest subjects were lumped into an age < 55 years category. Thus it is not even possible to know how many participants were pediatric aged. Despite these shortcomings, this study provides further reassurance that pediatric diabetes is not a major risk factor for severe COVID-19.