March 31, 2021
Understanding how challenging and unpredictable the COVID-19 pandemic is, especially for those impacted by type 1 diabetes (T1D), JDRF Canada continues to ensure that you have the credible and reliable information you need to help you better navigate the various and complex issues that are constantly arising.
In the early days of the pandemic, we outlined that children with T1D are not more susceptible to COVID-19 infection than their peers without T1D, and on average, children who developed COVID-19 were not at greater risk of worse COVID-19 outcomes. As the pandemic has progressed, data collection around the world has allowed a closer look at COVID-19 outcomes in different patient populations, and has reassuringly indicated that children, including those with various health concerns, generally experience mild symptoms of COVID-19. Nevertheless, new data presented at the virtual ENDO 2021 meeting on March 20, 2021 suggest some children with T1D and high HbA1c could have an increased risk of serious COVID-19 outcomes, compared with children who do not have diabetes.
What the study measured
The new study used data from 31 countries about 3047 children aged 0-18 with T1D and 502,655 children without diabetes who developed COVID-19. The research measured the risk of three outcomes: intubation, sepsis, or death due to COVID-19. The authors of the study assessed the difference in risk of these outcomes in children with T1D of differing HbA1c levels versus children without diabetes.
The results are reassuring in that the risk of any of these outcomes from COVID-19 in children with or without diabetes is extremely low (<0.5%). However, the results showed that the risk is slightly higher in children with T1D. Specifically, risk of death was 0.328% (ie, less than 1/300) in children with T1D and 0.047% (around 1/2000) in children without diabetes. The risk of intubation was 0.328% in children with T1D and 0.028% in children without diabetes, and for sepsis the figures were 0.492% and 0.114%, respectively.
Importantly, for children with HbA1c of less than or equal to 7% (16% of the children with T1D in the study sample), the risk was not increased: zero of these children experienced any of the COVID-19 outcomes measured. The study authors reported that these COVID-19 outcomes might be a greater concern in children with HbA1c of 9% or greater. However, the study relied on de-identified data from electronic health records, from the TriNetX database, and did not allow examination of patient-level data (e.g. charts) to analyze many potential confounding factors that could also influence risk of the outcomes studied. In addition, at this time, the full, peer-reviewed study has not yet been formally published. Thus, these preliminary results need to be interpreted with caution.
What this means
On the basis of these new data about COVID-19 outcomes in children, JDRF Canada does not recommend that children with T1D necessarily alter activities such as attending school or other permitted activities in-person; however, as advised throughout the pandemic, all public health precautions such as social distancing and hand and respiratory hygiene remain especially important. We advise anyone with questions about their individual family situation consult their healthcare provider.
It is encouraging that COVID-19 vaccines are now or will soon be tested in children as young as 6 months old which, pending Health Canada approval, will enable younger Canadians access to COVID-19 vaccination in the near future.
Click here more information on COVID-19 and T1D.