New research has linked the coronavirus to the onset of type 1 diabetes in children.
The infection is said to be mild in four out of five cases, with adolescents generally being particularly resistant. One study suggested children are half as likely to catch the virus in the first place, only to become seriously ill.
A minority of patients develop complications after overcoming the infection, however, with the coronavirus associated with everything from hearing loss to temporary brain damage.
Concerns are increased type 1 diabetes could be another side effect after 30 young people presented at hospitals in north-west London with a new case of the disease amid the peak of the outbreak.
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This is about double the number of new incidents that occurred in the same period over the last five years.
Although unclear, a protein on the coronavirus can attack insulin-producing cells in a patient’s pancreas, according to the authors of Imperial College London.
Not all 30 juveniles were tested for the pathogen, however, with only five showing evidence of a past or persistent infection.
Other experts noted the study “causes concern”, but added the evidence is “weak”.
Type 1 diabetes ‘unusually high’ in children with coronavirus
“It seems that children are at low risk of developing serious cases of COVID-19 [the disease triggered by the coronavirus]However, we need to consider potential health complications after exposure to the virus in children, ”said the study’s author, Karen Logan.
Between March 23 – when lockdown was implemented in the UK – until June 4, scientists analyzed data from five pediatric inpatient units across four North West London NHS trusts: Imperial College Healthcare, Chelsea & Westminster, The Hillingdon Hospital and London North West University Health Care.
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Results – published in the journal Diabetes Care – revealed an increase in type 1 cases in two of the units, each diagnosing 10 young patients.
This compares with an average of just two and four new incidents, respectively, in April and May over the past five years.
However, diagnostic rates in the other three units were similar to in the past.
“Our analysis shows that during the peak of the pandemic, the number of new cases of type 1 diabetes in children was unusually high in two of the hospitals in north-west London compared to previous years,” Logan said.
“When we further investigated, some of these children had active coronavirus or were previously exposed to the virus.”
Twenty-one of the adolescents – between 23 months and 16 years – were swabbed for the coronavirus after developing his fatal cough, two of which returned positive.
Sixteen were tested for antibodies to coronavirus – immune-fighting proteins circulating in the bloodstream, suggesting that an infection has already been fought.
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Three of these were positive, implying that five of the children had either been infected with the coronavirus in time or had already overcome it.
The scientists claim, however, this may be an underestimate.
“During the height of the pandemic, widespread access to testing was not available, so we may have missed more cases of COVID-19 in these children who have new-type type 1 diabetes,” said the study’s author. , Rebecca Unsworth.
Be ‘aware of this potential link’
Of the 30 patients, 70% came to the hospital with diabetic ketoacidosis (DKA), a serious complication that occurs when the body produces high levels of blood acids called ketones.
Type 1 diabetes occurs when the cells that produce insulin, the hormone that lowers blood sugar levels, are accidentally destroyed by a patient’s immune system.
If blood glucose levels are persistently increased, it can lead to serious complications such as a heart attack, blindness or even amputations of the limbs.
While it may sound alarming, type 1 diabetes can be controlled through injection or pumping.
DKA occurs when the body does not have enough insulin, which breaks down the fat as fuel. Ketones then accumulate, which can be life-threatening.
Of the DKA patients, more than half (52%) were in a critical condition – a much higher proportion than expected, according to the scientists.
Twelve of the children showed signs of clinical shock – a life-threatening condition that occurs when blood flow to the body is restricted, while four need to be treated in intensive care.
The scientists believe that their study is the first to see a potential link between the coronavirus and the development of type 1 diabetes in children, however, similar reports have emerged in China and Italy.
The coronavirus enters cells through the angiotensin-converting enzyme 2 (ACE2) receptor, which is “strongly expressed” in the pancreas.
The study was conducted to “raise awareness about a possible” but “not definitive” link between the coronavirus and new-onset type 1 diabetes.
“Our study was limited to one region in the UK and more research is needed to determine if there is a definite link between the two, but in the meantime we hope clinicians will consider this potential switch,” he said. Logan.
Other experts agree that additional research is needed.
Professor Julian Hamilton-Shield of the University of Bristol called the study “interesting”, but added “any suggestion of an increase in actual incidence should be treated with caution, as only units that contributed were larger than expected presentations. over a really short period of time “.
Professor Paul Hunter of the University of East Anglia found that the study “raises concerns”, with infections generally known to trigger DKA in “sensitive individuals”.
“However, the epidemiological evidence presented in this paper is weak and cannot be used as evidence of association,” he added.
“The main weakness of this paper is the identification of an increase in only two out of five inpatient units.
“In the UK, cases of new ketoacidosis will vary from year to year at any given time and it is often tempting, but it can be wrong to assume that whatever infection is common in the community is the cause of an increase in diagnosis that could have arisen simply by chance.
“Any association between diabetic ketoacidosis and COVID-19 may simply represent the association between ketoacidosis and any infection or in may represent something special for COVID-19.
“It is important that this observation is followed.”
