New-Onset Type 1 Diabetes in Children With SARS-CoV-2 Infection.

Shashikanth Ambati,David Charles Rosario,Javier Sanchez,Maya Mihic,Adnan Bakar

doi:10.7759/cureus.22790

Abstract

There has been a worldwide increase in cases of diabetic ketoacidosis in both adults and children with diabetes during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This can be multifactorial: delayed care due to reduced medical services, fear of approaching hospitals, or SARS-CoV-2 infection itself. It is well-known that infection is an important trigger for diabetic ketoacidosis in children with type 1 or type 2 diabetes mellitus, but little is known whether SARS-CoV-2 infection can trigger diabetic ketoacidosis and new-onset diabetes mellitus in a child with no previous history of diabetes mellitus. The association of SARS-CoV-2 as a trigger for new-onset diabetes requires further investigation, as the incidence of diabetes is steadily rising in the pediatric population during the pandemic. This case report explores two cases where children present in diabetic ketoacidosis with concurrent SARS-CoV-2 infection and no known history of type 1 diabetes mellitus.

Highlights

Adults with diabetes mellitus (DM) may be at higher risk of developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with an increased risk of morbidity and mortality [1]
The question is whether SARS-CoV-2 infection is directly related to the increased incidence of DM and diabetic ketoacidosis (DKA) in children or if the increased incidence is due to delay in seeking medical care due to the pandemic
Multiple hypotheses exist explaining how SARS-CoV-2 may trigger DM or DKA including SARS-CoV-2 directly binding to angiotensin-converting enzyme-2 (ACE-2) receptors in the pancreas resulting in islet cell damage or SARS-CoV-2 antibodies triggering an inflammatory process leading to beta-cell destruction and onset of DM [9-10]

Summary

Introduction

Adults with diabetes mellitus (DM) may be at higher risk of developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with an increased risk of morbidity and mortality [1]. There have been reports worldwide on new-onset DM in SARS-CoV-2 patients and increased incidence of diabetic ketoacidosis (DKA) in those with pre-existing DM [2-4] This trend has been noted in children during the pandemic, with a rise in both the incidence of new-onset type 1 DM and presentation in DKA [5-8]. A 10-year-old female presented with a five-day history of nausea, vomiting, diarrhea, and altered mental status Her initial laboratory testing was consistent with DKA (Table 1). The patient was given appropriate fluid resuscitation, started on an insulin infusion, and subsequently transferred to our pediatric intensive care unit (PICU) Of note, she had no previous diagnosis of type 1 DM, but it was noted upon further questioning that patient had polydipsia, polyuria, and 10-pound weight loss in the few weeks prior to admission. Case 1 Test Blood glucose (mg/dL) Venous blood gas pH Serum bicarbonate (mEq/L) Anion gap (mEq/L) Hemoglobin A1c (%)

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Disclosures