New-Onset Diabetes with Ketoacidosis Precipitated by COVID-19 in Children: A Report of Two Cases

Our plain-English summary of New-Onset Diabetes with Ketoacidosis Precipitated by COVID-19 in Children: A Report of Two Cases, by N. Chekhlabi, A. Haoudar, N. Echcharii, et al (Case Reports in Pediatrics, 2021).

The study

• Authors: N. Chekhlabi, A. Haoudar, N. Echcharii, S. Ettair, N. Dini
• Journal: Case Reports in Pediatrics
• Published: 2021;2021:5545258
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background And Aims: There is growing evidence that the 2019 coronavirus disease (COVID-19) is emerging as a potential trigger virus for the development of diabetes mellitus in children. This can occur even in patients without factors predisposing to impaired glucose metabolism. Here, we report two rare cases of diabetic ketoacidosis revealing new-onset diabetes and precipitated by COVID-19. These cases are reported in view of their rarity and originality. The relationship between type 1 diabetes mellitus and COVID-19 is discussed.

Results: Two children developed symptoms suggestive of diabetic ketoacidosis preceded by polyuria, polydipsia, and asbestos. There is a documented COVID-19 infection in the parents of the 2 children. An asymptomatic infection was detected in the 2 patients on the basis of a reverse transcription polymerase chain reaction (RT-PCR) test. Thoracic imaging and inflammatory workup were negative in both cases. Both patients responded well to treatment, including rehydration regimens and intravenous insulin. On the 2nd day of their hospitalization, they were transferred to several injections of subcutaneous insulin with therapeutic and nutritional education from the parents. After about 4 weeks, their insulin requirements probably decreased due to the diabetes honeymoon.

Conclusion: COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. More research data are needed to improve our knowledge of this constellation and to guide the most appropriate therapies.

Copyright © 2021 Nabila Chekhlabi et al.

In plain English

This article is not about asbestos. It is a case report from a paediatrics department in Casablanca, Morocco, describing two children who developed new diabetes with diabetic ketoacidosis, a dangerous build-up of acids in the blood, while infected with COVID-19. The girl, aged 4, had two parents who had tested positive for COVID-19. The boy, aged 7 years and 10 months, had a father with a recently confirmed infection. Both children tested positive for the virus by nasopharyngeal PCR. Their long-term blood sugar marker (HbA1c) was 11.8% in the girl and 10.3% in the boy. Diabetes-related antibodies were positive in the girl and negative in the boy. Both were treated with fluids and intravenous insulin, then switched to insulin injections, and neither received COVID-19-specific treatment. The girl left hospital after eight days with a diagnosis of new-onset type 1 diabetes and a concomitant COVID-19 infection. At follow-up the boy had low blood sugar, and his insulin doses were reduced. The authors concluded that COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children, and that more research is needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of two patients
• Who was studied: Two children: a 4-year-old girl with no prior medical history and a boy aged 7 years and 10 months. The authors are from a hospital in Casablanca, Morocco, and the article was published in 2021.
• Exposure: COVID-19 (SARS-CoV-2) infection in the children. Both of the girl's parents and the boy's father had confirmed COVID-19. No asbestos exposure is described.
• Main results:
  • Case 2 (the boy): his father had a recently confirmed COVID-19 infection.
  • Case 1 (the girl): HbA1c was 11.8%, and islet cell antibodies and glutamic acid decarboxylase antibodies were positive.
  • Case 1 was discharged after eight days with a diagnosis of new-onset type 1 diabetes and a concomitant COVID-19 infection.
  • Case 2 (the boy): HbA1c was 10.3%.
  • Case 2: diabetes-related antibodies were negative, and the SARS-CoV-2 RT-PCR test was positive.
  • Case 2 had low blood sugar at follow-up, and his insulin doses were reduced, with good progress.
  • No COVID-19-specific treatment was given to Case 1, and her control PCR test was negative on day 7 of hospitalization.
• The authors' conclusion: The authors concluded that COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. They also wrote that it can unmask existing diabetes and that further research is needed to confirm this relationship.

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