Pediatric COVID-19 and Diabetes: An Investigation into the Intersection of Two Pandemics

Coronavirus disease 2019 (COVID-19) is a complex infectious disease caused by the SARS-CoV-2 virus, and it currently represents a worldwide public health emergency. The pediatric population is less prone to develop severe COVID-19 infection, but children presenting underlying medical conditions, such as diabetes mellitus, are thought to be at increased risk of developing more severe forms of COVID-19. Diabetic children face new challenges when infected with SARS-CoV-2. On one hand, the glycemic values become substantially more difficult to manage as COVID-19 is a predisposing factor for hyperglycemia. On the other hand, alongside other risk factors, high glycemic values are incriminated in modulating immune and inflammatory responses, leading to potentially severe COVID-19 cases in the pediatric population. Also, there are hypotheses of SARS-CoV-2 being diabetogenic itself, but this information is still to be confirmed. Furthermore, it is reported that there was a noticeable increase in the number of cases of new-onset type 2 diabetes among the pediatric population, and the complications in these patients with COVID-19 include the risk of developing autoimmune diseases under the influence of stress. Additionally, children with diabetes mellitus are confronted with lifestyle changes dictated by the pandemic, which can potentially lead to the onset or exacerbation of a potential underlying anxiety disorder or depression. Since the literature contains a series of unknowns related to the impact of COVID-19 in both types of diabetes in children, the purpose of our work is to bring together the data obtained so far and to identify potential knowledge gaps and areas for future investigation regarding COVID-19 and the onset of diabetes type 1 or type 2 among the pediatric population.

[1]  T. Duong,et al.  Patients with prediabetes are at greater risk of developing diabetes 5 months postacute SARS-CoV-2 infection: a retrospective cohort study , 2023, BMJ Open Diabetes Research & Care.

[2]  I. Ilic,et al.  Diabetes Mellitus after SARS-CoV-2 Infection: An Epidemiological Review , 2023, Life.

[3]  T. Duong,et al.  COVID‐19 associated ketosis and diabetic ketoacidosis: A rapid review , 2023, Diabetes, obesity & metabolism.

[4]  I. Miron,et al.  SARS-CoV-2 Possible Etiology of Cerebral Venous Thrombosis in a Teenager: Case Report and Review of Literature , 2023, Viruses.

[5]  L. Mbuagbaw,et al.  Obesity and weight change during the COVID‐19 pandemic in children and adults: A systematic review and meta‐analysis , 2023, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[6]  L. Baur,et al.  Impact and recovery of the COVID‐19 pandemic on weight status of children and adolescents , 2023, Clinical obesity.

[7]  Meghan E Fredette,et al.  Incidence, Severity, and Presentation of Type 2 Diabetes in Youth During the First and Second Year of the COVID-19 Pandemic. , 2023, Diabetes care.

[8]  F. Chiarelli,et al.  COVID-19 and diabetes in children , 2022, Annals of pediatric endocrinology & metabolism.

[9]  Lee Smith,et al.  The global impact of COVID‐19 pandemic on the incidence of pediatric new‐onset type 1 diabetes and ketoacidosis: A systematic review and meta‐analysis , 2022, Journal of medical virology.

[10]  Minseung Kim,et al.  Comparison of Initial Presentation of Pediatric Diabetes Before and During the Coronavirus Disease 2019 Pandemic Era , 2022, Journal of Korean medical science.

[11]  C. Mantzoros,et al.  A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on , 2022, Metabolism.

[12]  Any Docu Axelerad,et al.  Neurological manifestations found in children with multisystem inflammatory syndrome. , 2022, Experimental and therapeutic medicine.

[13]  M. Sinha,et al.  Increase in the Number of Pediatric New-Onset Diabetes and Diabetic Ketoacidosis Cases During the COVID-19 Pandemic , 2022, Endocrine Practice.

[14]  S. Kahn,et al.  The Incidence of Diabetes Among 2,777,768 Veterans With and Without Recent SARS-CoV-2 Infection , 2022, Diabetes care.

[15]  C. Longhurst,et al.  Incidence of New-Onset Type 1 Diabetes Among US Children During the COVID-19 Global Pandemic. , 2022, JAMA pediatrics.

[16]  S. Saydah,et al.  Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years — United States, March 1, 2020–June 28, 2021 , 2022, MMWR. Morbidity and mortality weekly report.

[17]  S. Nagafuchi,et al.  SARS-CoV-2 Infection and Pancreatic β Cell Failure , 2021, Biology.

[18]  V. Calcaterra,et al.  Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review , 2021, Nutrients.

[19]  E. C. Young,et al.  Diabetic ketoacidosis and COVID-19: what have we learned so far? , 2021, American journal of physiology. Endocrinology and metabolism.

[20]  C. de Beaufort,et al.  The Challenges of Managing Pediatric Diabetes and Other Endocrine Disorders During the COVID-19 Pandemic: Results From an International Cross-Sectional Electronic Survey , 2021, Frontiers in Endocrinology.

[21]  B. Tchana,et al.  Improvement in glycaemic control in paediatric and young adult type 1 diabetes patients during COVID-19 pandemic: role of telemedicine and lifestyle changes , 2021, Acta bio-medica : Atenei Parmensis.

[22]  Jo-Fen Liu,et al.  Multicentre service evaluation of presentation of newly diagnosed cancers and type 1 diabetes in children in the UK during the COVID-19 pandemic , 2021, BMJ Paediatrics Open.

[23]  S. Boppana,et al.  SARS-CoV-2 infection in hospitalized children with type 1 and type 2 diabetes , 2021, Journal of Clinical & Translational Endocrinology.

[24]  T. Nakagawa,et al.  A Child With COVID-19, Type 1 Diabetes, and Candida glabrata: A Case Report and Literature Review , 2021, Clinical pediatrics.

[25]  E. Kostopoulou,et al.  Impact of COVID-19 on new-onset type 1 diabetes mellitus - A one-year prospective study. , 2021, European review for medical and pharmacological sciences.

[26]  D. Freedman,et al.  Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020 , 2021, MMWR. Morbidity and mortality weekly report.

[27]  N. Behniafard,et al.  New onset of diabetes in a child infected with COVID-19: a case report , 2021, Journal of Diabetes & Metabolic Disorders.

[28]  J. Shirakawa Pancreatic β‐cell fate in subjects with COVID‐19 , 2021, Journal of diabetes investigation.

[29]  B. Timar,et al.  Increased Incidence of Type 1 Diabetes during the COVID-19 Pandemic in Romanian Children , 2021, Medicina.

[30]  V. Calcaterra,et al.  Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: The double-wave occurrence , 2021, EClinicalMedicine.

[31]  B. Barton,et al.  COVID-19 Pandemic and Pediatric Type 1 Diabetes: No Significant Change in Glycemic Control During The Pandemic Lockdown of 2020 , 2021, Frontiers in Endocrinology.

[32]  A. Szadkowska,et al.  Diabetes Related Distress in Children with Type 1 Diabetes before and during the COVID-19 Lockdown in Spring 2020 , 2021, International journal of environmental research and public health.

[33]  R. Amin,et al.  The SARS‐CoV‐2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi‐centre study of the first COVID‐19 wave , 2021, Diabetic medicine : a journal of the British Diabetic Association.

[34]  D. Hsia,et al.  153-LB: Initial Presentation of Children with Type 2 Diabetes during the COVID-19 Pandemic , 2021, Diabetes.

[35]  C. Muñoz,et al.  Impact of COVID-19 on Youth With Type 2 Diabetes: Lessons Learned From a Pediatric Endocrinologist and a Psychologist , 2021, Frontiers in Endocrinology.

[36]  M. Mulekar,et al.  Effect of Covid-19 quarantine on diabetes Care in Children , 2021, Clinical Diabetes and Endocrinology.

[37]  F. Collins,et al.  SARS-CoV-2 infection induces beta cell transdifferentiation , 2021, Cell Metabolism.

[38]  G. Nolan,et al.  SARS-CoV-2 infects human pancreatic β cells and elicits β cell impairment , 2021, Cell Metabolism.

[39]  M. Knip,et al.  New-onset type 1 diabetes in Finnish children during the COVID-19 pandemic , 2021, Archives of Disease in Childhood.

[40]  W. Kraus,et al.  Weight-Related Behaviors of Children with Obesity during the COVID-19 Pandemic. , 2021, Childhood obesity.

[41]  G. Alonso,et al.  Diabetic ketoacidosis drives COVID‐19 related hospitalizations in children with type 1 diabetes , 2021, Journal of diabetes.

[42]  Kathleen M. Matic SARS-CoV-2 and Multisystem Inflammatory Syndrome In Children (MIS-C) , 2021, Current Problems in Pediatric and Adolescent Health Care.

[43]  D. Pacaud,et al.  Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID‐19 pandemic , 2021, Pediatric diabetes.

[44]  S. Bhadada,et al.  COVID-19 vaccination in patients with diabetes mellitus: Current concepts, uncertainties and challenges , 2021, Diabetes & Metabolic Syndrome: Clinical Research & Reviews.

[45]  P. Moceri,et al.  Multisystem inflammatory syndrome in children and adults (MIS-C/A): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data , 2021 .

[46]  K. Nielsen-Saines,et al.  Case Report: Insulin-Dependent Diabetes Mellitus and Diabetic Keto-Acidosis in a Child With COVID-19 , 2021, Frontiers in pediatrics.

[47]  S. Luo,et al.  Glycemic control in children and teenagers with type 1 diabetes around lockdown for COVID‐19: A continuous glucose monitoring‐based observational study , 2021, Journal of diabetes investigation.

[48]  S. Dominguez,et al.  Risk Factors for Severe COVID-19 in Children. , 2021, The Pediatric infectious disease journal.

[49]  A. Alfadda,et al.  The impact of a prolonged lockdown and use of telemedicine on glycemic control in people with type 1 diabetes during the COVID-19 outbreak in Saudi Arabia , 2021, Diabetes Research and Clinical Practice.

[50]  M. Rachmiel,et al.  Glycaemic control in the paediatric and young adult population with type 1 diabetes following a single telehealth visit - what have we learned from the COVID-19 lockdown? , 2021, Acta Diabetologica.

[51]  M. Manco,et al.  Childhood Obesity and COVID-19 Lockdown: Remarks on Eating Habits of Patients Enrolled in a Food-Education Program , 2021, Nutrients.

[52]  N. Tandon,et al.  Changes to care delivery at nine international pediatric diabetes clinics in response to the COVID‐19 global pandemic , 2021, Pediatric diabetes.

[53]  Priyanka Madaan,et al.  Psychological and Behavioral Impact of Lockdown and Quarantine Measures for COVID-19 Pandemic on Children, Adolescents and Caregivers: A Systematic Review and Meta-Analysis , 2020, Journal of tropical pediatrics.

[54]  B. Roep,et al.  Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?) , 2020, Nature Reviews Endocrinology.

[55]  L. Iughetti,et al.  Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic , 2020, Frontiers in Endocrinology.

[56]  A. McCoy,et al.  COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2 Diabetes , 2020, Diabetes Care.

[57]  A. Woll,et al.  Physical activity and screen time of children and adolescents before and during the COVID-19 lockdown in Germany: a natural experiment , 2020, Scientific Reports.

[58]  J. Allaire,et al.  Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis , 2020, International Journal of Infectious Diseases.

[59]  D. Maahs,et al.  Children and youth with diabetes are not at increased risk for hospitalization due to COVID‐19 , 2020, Pediatric diabetes.

[60]  Alaina P. Vidmar,et al.  New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19 , 2020, Journal of pediatric endocrinology & metabolism : JPEM.

[61]  M. Storz The COVID-19 pandemic: an unprecedented tragedy in the battle against childhood obesity , 2020, Clinical and experimental pediatrics.

[62]  J. Argente,et al.  Severity in pediatric type 1 diabetes mellitus debut during the COVID-19 pandemic , 2020, Journal of pediatric endocrinology & metabolism : JPEM.

[63]  E. Hod,et al.  Distinct antibody responses to SARS-CoV-2 in children and adults across the COVID-19 clinical spectrum , 2020, Nature Immunology.

[64]  N. Wright,et al.  Presentation of newly diagnosed type 1 diabetes in children and young people during COVID-19: a national UK survey , 2020, BMJ paediatrics open.

[65]  J. Nahar,et al.  Young people with type 1 diabetes on insulin pump therapy could fast safely during COVID–19 pandemic Ramadan: A telemonitoring experience in Bangladesh , 2020, Journal of diabetes investigation.

[66]  J. Ludvigsson Effect of COVID‐19 pandemic on treatment of Type 1 diabetes in children , 2020, Acta paediatrica.

[67]  I. Rabbone,et al.  Seasonal flu and COVID‐19 recommendations for children, adolescents and young adults with diabetes , 2020, Diabetic medicine : a journal of the British Diabetic Association.

[68]  Maria C Trissal,et al.  Toddler With New Onset Diabetes and Atypical Hemolytic-Uremic Syndrome in the Setting of COVID-19 , 2020, Pediatrics.

[69]  A. Alsheikh-Ali,et al.  Regulation of Angiotensin- Converting Enzyme 2 in Obesity: Implications for COVID-19 , 2020, Frontiers in physiology.

[70]  T. Urakami Severe Hypoglycemia: Is It Still a Threat for Children and Adolescents With Type 1 Diabetes? , 2020, Frontiers in Endocrinology.

[71]  E. Bonifacio,et al.  Autoantibody-negative insulin-dependent diabetes mellitus after SARS-CoV-2 infection: a case report , 2020, Nature Metabolism.

[72]  César Martín,et al.  Pathophysiology of Type 2 Diabetes Mellitus , 2020, International journal of molecular sciences.

[73]  J. Rosenbauer,et al.  Did the COVID-19 Lockdown Affect the Incidence of Pediatric Type 1 Diabetes in Germany? , 2020, Diabetes Care.

[74]  R. Sonabend,et al.  Isolation and Education During a Pandemic: Novel Telehealth Approach to Family Education for a Child With New-Onset Type 1 Diabetes and Concomitant COVID-19 , 2020, Clinical Diabetes.

[75]  N. Oliver,et al.  New-Onset Type 1 Diabetes in Children During COVID-19: Multicenter Regional Findings in the U.K. , 2020, Diabetes Care.

[76]  I. Rabbone,et al.  Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children? , 2020, Diabetes Care.

[77]  M. Bean,et al.  Food Insecurity, the Home Food Environment, and Parent Feeding Practices in the Era of COVID‐19 , 2020, Obesity.

[78]  C. Nogueira-de-Almeida,et al.  COVID-19 and obesity in childhood and adolescence: a clinical review , 2020, Jornal de Pediatria.

[79]  T. Rohrer,et al.  Ketoacidosis in Children and Adolescents With Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic in Germany. , 2020, JAMA.

[80]  S. Del Prato,et al.  COVID-19 in people with diabetes: understanding the reasons for worse outcomes , 2020, The Lancet Diabetes & Endocrinology.

[81]  G. Frühbeck,et al.  Obesity and COVID-19: The Two Sides of the Coin , 2020, Obesity Facts.

[82]  Sm Ng COVID‐19 and children with diabetes: emerging knowledge , 2020, Practical Diabetes.

[83]  J. Fernández-Río,et al.  Weight changes during the COVID-19 home confinement. Effects on psychosocial variables. , 2020, Obesity research & clinical practice.

[84]  D. Dayal,et al.  Missing during COVID‐19 lockdown: Children with onset of type 1 diabetes , 2020, Acta paediatrica.

[85]  K. Khunti,et al.  New-Onset Diabetes in Covid-19 , 2020, The New England journal of medicine.

[86]  N. Agarwal,et al.  Severe Diabetic Ketoacidosis in a Child with Type-1 Diabetes, Asthma, and COVID-19 , 2020, Journal of Pediatric Intensive Care.

[87]  Nudrat Noor,et al.  Type 1 Diabetes and COVID-19: Preliminary Findings From a Multicenter Surveillance Study in the U.S. , 2020, Diabetes Care.

[88]  Piotr Rzymski,et al.  Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland , 2020, Nutrients.

[89]  L. Barrea,et al.  Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey , 2020, Journal of Translational Medicine.

[90]  Mou Dutta COVID-19 and Impact of School Closures on the Children of the United States; a Point of View with an Empirical Analysis , 2020 .

[91]  T. Skoff,et al.  Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[92]  A. Rundle,et al.  COVID‐19–Related School Closings and Risk of Weight Gain Among Children , 2020, Obesity.

[93]  G. Wong,et al.  SARS-CoV-2 Infection in Children , 2020, The New England journal of medicine.

[94]  Zunyou Wu,et al.  Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. , 2020, JAMA.

[95]  G. Gao,et al.  A Novel Coronavirus from Patients with Pneumonia in China, 2019 , 2020, The New England journal of medicine.

[96]  J. Carpenter,et al.  Ethnic Differences in the Prevalence of Type 2 Diabetes Diagnoses in the UK: Cross-Sectional Analysis of the Health Improvement Network Primary Care Database , 2019, Clinical epidemiology.

[97]  E. Mayer-Davis,et al.  ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents , 2018, Pediatric diabetes.

[98]  M. Knip,et al.  ISPAD Clinical Practice Consensus Guidelines 2018: Stages of type 1 diabetes in children and adolescents , 2018, Pediatric diabetes.

[99]  A. Pulungan,et al.  Type 2 diabetes mellitus in children and adolescent: an Indonesian perspective , 2018, Annals of pediatric endocrinology & metabolism.

[100]  D. Hale,et al.  Type 2 diabetes in a 5‐year‐old and single center experience of type 2 diabetes in youth under 10 , 2017, Pediatric diabetes.

[101]  W. Tamborlane,et al.  A cross‐sectional view of the current state of treatment of youth with type 2 diabetes in the USA: enrollment data from the Pediatric Diabetes Consortium Type 2 Diabetes Registry , 2017, Pediatric diabetes.

[102]  D. Dunger,et al.  Expanding Treatment Options for Youth With Type 2 Diabetes: Current Problems and Proposed Solutions , 2016, Diabetes Care.

[103]  J. Edge,et al.  Diabetic ketoacidosis and hyperglycemic hyperosmolar state , 2014 .

[104]  T. Reinehr,et al.  Type 2 diabetes mellitus in children and adolescents. , 2013, World journal of diabetes.

[105]  M. V. von Herrath,et al.  Viral Trigger for Type 1 Diabetes , 2008, Diabetes.

[106]  G. Navis,et al.  Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis , 2004, The Journal of pathology.

[107]  K. Dżygało,et al.  Increased frequency of severe diabetic ketoacidosis at type 1 diabetes onset among children during COVID-19 pandemic lockdown: an observational cohort study. , 2020, Pediatric endocrinology, diabetes, and metabolism.

[108]  UK Prospective Diabetes Study Group Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration , 2007, Diabetologia.

[109]  G. Theintz,et al.  [Diabetes in childhood and adolescence]. , 1994, Schweizerische medizinische Wochenschrift. Supplementum.