For over a year now the Type 1 diabetes community has been eagerly awaiting better data on the risk posed by the novel coronavirus. While we now more or less understand the risks to adults, the hazards to children and teens with T1D have remained a mystery. And although our kids are not generally thought to be at much risk of severe illness from Covid-19, many parents and caretakers of kids with T1D have understandably been nervous about what the disease might mean for their family.
Now we finally have some data. There’s very good news… and very bad news.
Here’s a summary, courtesy of Medscape’s Miriam Tucker:
Results from over 3000 children with Type 1 diabetes and more than 500,000 without suggest that rates of mortality, intubation, and sepsis with COVID-19 were no greater in those with Type 1 diabetes, as long as they had A1c levels < 7{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497}.
However, rates for those COVID-19 outcomes were significantly higher among children with Type 1 diabetes and A1c levels > 9{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497}.
So, first, the great news: children with T1D that have well-controlled blood sugar (HbA1c < 7{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497}) are at no more risk of death or severe illness than are their non-diabetic siblings and peers.
But the very bad news: children with poorly controlled T1D are at a hugely increased risk of severe Covid outcomes.
Dr. Manish Raisingani, who presented the findings during the virtual ENDO 2021 conference, used the results to make a concrete suggestion, which I’ll put into bold: “Our findings indicate that if their A1c is high, it would be best to have them attend virtual school, but if it’s 7{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497} or under, their risk is similar to other children without type 1 diabetes.” Another expert contacted by Medscape—Dr. Robert Lash, a leader at the Endocrine Society, the organization sponsoring the conference—said that he agreed with Dr. Raisingani’s advice.
The study in question used data from the immense TriNetX database. Investigators analyzed over 300,000 children (ages 0-18) who contracted Covid-19; about 2,000 of the children had Type 1 diabetes.
The mortality rate of the kids without diabetes was 0.047{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497}—about 1 in every 2,000. But for those with poorly controlled T1D had a risk of complications—death, sepsis and intubation—about 10 times higher. For some perspective, 1 death in every 200 approaches the best estimates for Covid-19 mortality rate among adults, and is roughly equivalent to the case fatality rate of malaria.
The full study has not yet been made available, but Dr. Raisingani indicated that risks got substantially worse as glycemic control got worse: “As the A1c goes from 9{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497} to 10{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497}, the risk increases exponentially.”
We have now known for about a year how important good blood sugar control is as a defense against the worst consequences of the novel coronavirus. Experts have known from the earliest days of the pandemic that adults with Type 2 diabetes were more likely to experience severe outcomes of Covid-19, and soon learned that glycemic control had a lot to do with the progression and severity of the disease. In the ensuing months, experts began to recommend that patients “intensify metabolic control … as means of primary prevention of Covid-19 disease.” Soon after we also learned that adults with Type 1 diabetes also had an increased risk of severe Covid outcomes, a risk that was significantly tied to the quality of a patient’s blood sugar control.
Given that the vast majority of children fail to meet the American Diabetes Association’s targets for healthy A1c, children with T1D should probably be considered a higher risk population. We can hope that children with diabetes will be given priority when the time comes to vaccinate children; as of yet, no vaccine has been approved for use with minors. In the meantime, parents and caregivers of T1D children would be wise to take diabetes management very seriously, in addition to following all guidelines for masking, social distancing and infection hygiene.
Dr. Raisingani concluded: “This study shows keeping diabetic children’s blood sugar under control is more important than ever during the pandemic.”
