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 However, specific data was not reported and the note was not peer reviewed per se.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.
Addendum – September 22, 2020: Another reassuring report has just been published in the journal Diabetes Care. The authors report a community-based, retrospective review of hospitalization rates among adults with type 1 diabetes versus the general population. A total of 2,336 persons with type 1 diabetes were examined. The percentage of these persons hospitalized for COVID-19 was 0.21%. This was not statistically different than the rate among the general population in the region which was 0.17%. The authors conclude that type 1 diabetes does not increase the risk that a person will develop COVID-19 of sufficient severity to warrant hospitalization. The study was performed in Belgium. There are limitations that prevent full reassurance from this data. In particular, it is possible (or even probable) that persons with type 1 diabetes were more cautious in avoiding COVID-19 exposure than the general population, and this possibility was not examined.