The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.
J Clin Endocrinol Metab. 2022 Jul 14;107(8):e3264-e3272. doi: 10.1210/clinem/dgac288.
Data is needed regarding the effect of SARS-CoV-19 infection on young people with established type 1 diabetes. Identifying the disease outcomes, short and long-term sequelae may help to establish an evidence-based prevention and education policy for sick days management and DKA prevention.
This work aims to describe clinical manifestations of SARS-CoV-2 infection in children, adolescents, and young adults with established type 1 diabetes (T1D) and explore the effects of COVID-19 on glycemic control and disease course.
An observational study was conducted at 3 pediatric diabetes clinics in Israel between mid-March 2020 and mid-March 2021. Included were young people with established T1D, age younger than 30 years, who tested positive for SARS-CoV-2 (quantitative real-time polymerase chain reaction). Data were collected from medical files, diabetes devices, and COVID-19 questionnaire. Outcome measures were analyzed by the presence/absence of clinical symptoms (symptomatic/asymptomatic) and by age group (pediatric, < 19 years/young adults, 19-30 years).
Of 132 patients, mean age 16.9 ± 5.3years, with COVID-19-confirmed infection, 103 (78%) had related symptoms; the most common were headaches, fatigue, fever, and loss of sense of smell. All had a mild disease course, but 4 required hospitalization and 2 cases were directly related to COVID-19 infection (pleuropneumonia in a patient with immunodeficiency syndrome, 1 case of diabetic ketoacidosis). Logistic regression analysis showed that age (odds ratio [OR] = 1.11; 95% CI, 1.01-1.23; P = .033), elevated glucose levels (OR = 5.23; 95% CI, 1.12-24.41; P = .035), and comorbidities (OR = 8.21; 95% CI, 1.00-67.51; P = .050) were positively associated with symptomatic infection. Persistent symptoms occurred in 16.5% of the cohort over a median of 6.7 months; age (OR = 1.14; 95% CI, 1.01-1.29; P = .030) and elevated glucose levels (OR = 3.42; 95% CI, 1.12-10.40; P = .031) were positively associated with persistent symptoms. Usually, no change was reported in glucose levels (64%) except for a temporary deterioration in glycemic control during the short infection period.
Young people with established T1D experience mild COVID-19 infection. Elevated glucose levels during COVID-19 infection and older age were associated with prolonged disease course.
需要了解 SARS-CoV-19 感染对已确诊 1 型糖尿病的年轻人的影响。确定疾病结局和短期及长期后遗症有助于为病假管理和糖尿病酮症酸中毒预防制定基于证据的预防和教育政策。
本研究旨在描述儿童、青少年和年轻成人中已确诊 1 型糖尿病（T1D）患者感染 SARS-CoV-2 的临床表现，并探讨 COVID-19 对血糖控制和疾病进程的影响。
2020 年 3 月中旬至 2021 年 3 月中旬，在以色列的 3 家儿科糖尿病诊所进行了一项观察性研究。纳入的对象为年龄小于 30 岁且 SARS-CoV-2 检测结果为阳性（实时定量聚合酶链反应）的已确诊 T1D 年轻患者。数据来自病历、糖尿病设备和 COVID-19 调查问卷。通过有无临床症状（有症状/无症状）和年龄组（儿科，<19 岁/青年，19-30 岁）来分析结局指标。
在 132 名确诊 COVID-19 感染的患者中，平均年龄 16.9±5.3 岁，103 名（78%）有相关症状；最常见的是头痛、疲劳、发热和嗅觉丧失。所有患者的疾病过程均较轻，但 4 名患者需要住院治疗，2 例与 COVID-19 感染直接相关（1 例免疫缺陷综合征患者并发肺炎，1 例糖尿病酮症酸中毒）。逻辑回归分析显示，年龄（比值比 [OR] = 1.11；95%置信区间，1.01-1.23；P = 0.033）、血糖升高（OR = 5.23；95%置信区间，1.12-24.41；P = 0.035）和合并症（OR = 8.21；95%置信区间，1.00-67.51；P = 0.050）与有症状感染呈正相关。在中位时间为 6.7 个月时，队列中有 16.5%的患者持续出现症状；年龄（OR = 1.14；95%置信区间，1.01-1.29；P = 0.030）和血糖升高（OR = 3.42；95%置信区间，1.12-10.40；P = 0.031）与持续症状呈正相关。除了在短期感染期间血糖控制暂时恶化外，通常报告血糖水平无变化（64%）。
已确诊 1 型糖尿病的年轻人发生轻度 COVID-19 感染。COVID-19 感染期间血糖升高和年龄较大与疾病进程延长有关。
