COVID-19 infection may be associated with an increased risk of Type I diabetes in children, according to a new study published by researchers from Imperial College Healthcare NHS Trust.

Diabetes emerged as a high risk factor for severe COVID-19 disease in the early days of the pandemic. But the new study, published in the Diabetes Care Journal, seemed to imply that the opposite relationship could also exist, and that coronavirus infection may be associated with a risk of developing diabetes.

“It appears that children are at low risk of developing serious cases of COVID-19. However, we do need to consider potential health complications following exposure to the virus in children,” said Karen Logan, a clinical nurse specialist at Imperial College Healthcare NHS Trust, and supervising author on the study.

Children have been largely spared from the worst effects of the COVID-19 pandemic, which has hit older people and those with preexisting chronic conditions hard. However, keen clinicians have linked rare complications in children to COVID-19 infection in the past, as in the case of an uncommon, Kawasaki disease-like syndrome that causes inflammation of the blood vessels.

Although the diabetes study only followed a cluster of hospitals in northwest London, some 30 children in hospitals across five paediatric inpatient unites presented with new-onset type I diabetes between 23 March and 4 June, the peak of the pandemic in London. Type I diabetes occurs when damage to the pancreatic cells renders them unable to produce insulin, a hormone that is required to help the body process sugars.

The increase in new type I diabetes cases was highest in two of five paediatric inpatients units, which both saw 10 cases of new-onset type I diabetes during the study, compared to an average of 2-4 cases during the same time period in previous years.

Five out of the 30 children had tested positive for either active or previous COVID-19 infection, although 14 children were not tested in all.

“We believe this study is the first to show a potential link between COVID-19 and the development of type 1 diabetes in some children,” added Logan. However, she noted that the study was limited to only one region in the UK, and more research is required to establish whether there is a definitive link between COVID-19 and new onset Type I diabetes.

Additionally, testing was limited during the peak of the pandemic, so not all the children in the cohort were able to be tested for COVID-19, according to Rebecca Unsworth, lead author on the study.

“In the meantime we hope clinicians will be mindful of this potential link,”  said Logan.

Strong Link Between Diabetes & Death By COVID-19

Meanwhile, a massive study recently published in the Lancet found a strong link between type I diabetes, type 2 diabetes and risk of COVID-19 related death.

Conducted by researchers at Public Health England and the NHS, the study analyzed data from over 6 million patients registered with general practitioners, and 23,698 COVID-19 hospital deaths. The researchers found that over a third of coronavirus deaths between 1 March and 11 May occurred in people with a previous diabetes diagnosis.

“To our knowledge, this is the largest COVID-19-related population study, covering almost the entire population of England, and is the first study to investigate the relative and absolute risks of death in hospital with COVID-19 by type of diabetes,” the authors wrote.

While previous studies have already established that people with diabetes are at increased risk of experiencing severe COVID-19 disease or death, the new study found that the mortality rate was highest in patients with Type 2 diabetes.

However, after adjusting for demographic factors – such as age, sex and poverty – the study found that those with type I diabetes had 3.51 times the odds of dying by COVID-19 compared to patients without diabetes. Patients with type 2 diabetes had 2.03 times the odds of dying by COVID-19 compared to those without diabetes.

Patients with diabetes who were under the age of 40 had a lower risk of dying by COVID-19. However, the study did not analyze deaths in care homes, which accounted for approximately 70% of COVID-19 deaths in England during the study period.

Image Credits: WHO, Flickr: Jill Brown.