Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Diabetes Care. 2022 Oct 1;45(10):2406-2411. doi: 10.2337/dc22-0396.
Although mortality from coronavirus disease 2019 (COVID-19) among youth with type 1 diabetes is rare, severe acute respiratory syndrome coronavirus 2 is associated with increased pediatric hospitalizations for diabetic ketoacidosis (DKA). To clarify whether the relationship between COVID-19 and DKA is coincidental or causal, we compared tissue glucose disposal (TGD) during standardized treatment for DKA between pediatric patients with COVID-19 and those without COVID-19.
We retrospectively compared TGD during standardized therapy for DKA in all children with preexisting type 1 diabetes with or without COVID-19. Cases were assessed beginning with the first case of COVID-19-positive DKA on 19 June 2020 through 2 February 2022.
We identified 93 COVID-19-negative patients and 15 COVID-19-positive patients who were treated for DKA, with similar baseline characteristics between groups. Median TGD was 46% lower among patients who had COVID-19 compared with those who did not (P = 0.013).
These results suggest that COVID-19 provokes a metabolic derangement over and above factors that typically contribute to pediatric DKA. These findings underscore the significant and direct threat posed by COVID-19 in pediatric type 1 diabetes and emphasize the importance of mitigation and monitoring including through vaccination as a primary prevention.
尽管 COVID-19 导致 1 型糖尿病青少年的死亡率罕见，但严重急性呼吸综合征冠状病毒 2 与儿童因糖尿病酮症酸中毒（DKA）住院增加有关。为了明确 COVID-19 与 DKA 之间的关系是偶然的还是因果关系，我们比较了 COVID-19 阳性和 COVID-19 阴性儿科患者在标准化 DKA 治疗期间的组织葡萄糖处置（TGD）。
我们回顾性比较了 2020 年 6 月 19 日至 2022 年 2 月期间所有患有 1 型糖尿病且 COVID-19 阳性或阴性的儿童在标准化 DKA 治疗期间的 TGD。病例评估从首次 COVID-19 阳性 DKA 开始，直到 2022 年 2 月。
我们确定了 93 例 COVID-19 阴性患者和 15 例 COVID-19 阳性患者，他们因 DKA 接受了治疗，两组患者的基线特征相似。与 COVID-19 阴性患者相比，COVID-19 阳性患者的 TGD 中位数低 46%（P = 0.013）。
这些结果表明，COVID-19 引起的代谢紊乱超出了通常导致儿科 DKA 的因素。这些发现强调了 COVID-19 在儿科 1 型糖尿病中的重大和直接威胁，并强调了通过疫苗接种等一级预防来减轻和监测的重要性。
