Surge of pediatric patients with diabetic ketoacidosis during COVID-19 pandemic

In general, children appear to be less severely affected by COVID-19 than adults, according to the Centers for Disease Control and Prevention (CDC). But a new study from Children’s Hospital Los Angeles shows the pandemic could affect children’s health in unexpected ways. The study reveals an increase in the number of patients with diabetic ketoacidosis, a serious complication of type 2 diabetes. These data, published today in Diabetes Care, provide additional insights into the impact of the pandemic on the country’s children.

Diabetic ketoacidosis, or DKA, is life-threatening. “DKA occurs when insulin levels in the blood drop too low for too long. Insulin helps the body use glucose. So when there isn’t enough insulin, the body starts to break down fat as an energy source.”

Lily Chao, MD, MS, interim Medical Diabetes Director at CHLA

This process, she says, creates dangerously high levels of acids in the blood. If left untreated, it can lead to brain edema, coma or even death. “Children come in with dehydration and DKA. But DKA is preventable and reversible if we treat it early and properly,” says Dr. Chao, the paper’s lead author.

Dr. Chao and her colleagues noticed in March 2020 that more and more patients came in with DKA and type 2 diabetes. “We used to see a few cases of DKA in type 2 diabetes per year,” she says, “and suddenly we saw a spike, so we started tracking. Now we have the numbers to confirm that there are more children with type 2 diabetes who have this very serious complication of DKA. “

Still, the question remains, what causes the increased incidence of type 2 diabetes with DKA?

A year after the COVID-19 pandemic, many children are used to wearing masks and attending online classes. But other changes have also had an impact. Fewer children may be coming to the doctor for their routine good-child exams, possibly because of the fear families feel about exposure to SARS-CoV-2, the virus that causes COVID-19.

“Parents are concerned about going out,” says Dr. Chao. “Some families have to take public transportation to get to the pediatrician and are reluctant to do so during the pandemic.”

This, she says, may be one of the reasons for the shift she and her colleagues have seen.

In addition to missing doctor visits, other factors may play a role, such as less physical activity during lockdown or reduced access to fresh, healthy food. But there may also be a biological relationship between exposure to the virus and diabetes.

“There is definitely a link between COVID-19 and diabetes,” said Senta Georgia, PhD, a researcher at The Saban Research Institute of Children’s Hospital Los Angeles and senior author of the paper. Dr. Georgia has a fundamental and translational research program aimed at understanding the cellular biology of diabetes and developing new therapies. “We don’t know if SARS-CoV-2 infects insulin-secreting cells in the pancreas,” she says. “There have been some reports of an association between COVID-19 and diabetes in adults, but no pediatric studies have been published to date.”

As a physician scientist and laboratory scientist respectively, Dr. Chao and Dr. Georgia unique perspectives – but their goals converge in getting answers to help children diagnosed with diabetes.

“Our collaboration at Children’s Hospital Los Angeles allows us to address children’s health on multiple levels,” said Dr. Georgia. “I help Dr. Chao design her clinical studies and she is collaborating with me on our basic and translational research. So we come to the problem of increased incidence of diabetes from both a clinical and scientific perspective.”

Future translational and clinical studies can determine whether increased DKA in patients can be caused by infection with SARS-CoV-2. But for now, the data clearly points to an emerging trend toward more serious diabetes complications during the global pandemic.

The team hopes these findings increase vigilance. “It is critical for pediatricians to recognize that when a child shows symptoms of diabetes, the child should be immediately evaluated,” says Dr. Chao. “The sooner we see these children, the more likely we are to prevent DKA.”


Children’s Hospital Los Angeles

Journal reference:

Chao, LC, et al. (2021) Peak Diabetic Ketoacidosis Rates in Pediatric Type 2 Diabetes During the COVID-19 Pandemic. Diabetes Care.

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