COVID-19 Resource Center

COVID-19 Resource Center

Disclosures: Alonso reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
May 11, 2021
3 min read

DKA common among children with type 1 diabetes hospitalized for COVID-19

Disclosures: Alonso reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Most children with type 1 diabetes who test positive for COVID-19 do not require hospitalization, although most hospitalized children had diabetic ketoacidosis at admission, according to study findings.

“Most children with type 1 diabetes who had COVID-19 were cared for at home without adverse outcomes, and only 2% of patients needed respiratory support,” G. Todd Alonso, MD, an associate professor at the Barbara Davis Center for Diabetes at the University of Colorado, told Healio. “Nearly three-quarters of those who were admitted to the hospital experienced DKA on admission, and there were no deaths. This should provide measured reassurance for caregivers of children with type 1 diabetes, though more needs to be done to lower the risk of DKA.”

Diabetic ketoacidosis occurred in nearly three-quarters of children with type 1 diabetes hospitalized with COVID-19. Data were derived from Alonso GT, et al. J Diabetes. 2021;doi:10.1111/1753-0407.13184.

Alonso and colleagues analyzed data from 52 diabetes centers that provided information on children younger than 19 years with type 1 diabetes who tested positive for COVID-19. Diabetes centers submitted patient data through a survey featuring 33 questions on demographics, duration of diabetes, presenting COVID-19 symptoms, diabetes management and device use, comorbidities, relevant behaviors, level of care, duration of COVID-19 symptoms and clinical outcomes. Data were collected between April 9, 2020, and Jan. 15, 2021.

Hospitalization more common for Black youths

There were 266 youths with type 1 diabetes who tested positive for COVID-19 included in the study. Of the study cohort, 61 were hospitalized. Ten who were hospitalized were originally admitted for reasons unrelated to COVID-19 or type 1 diabetes.

Of those who were not hospitalized, 61% were non-Hispanic white children and 13% were non-Hispanic Black youths, whereas 34% of hospitalized children were non-Hispanic Black and 33% non-Hispanic white. Those who were hospitalized were more likely to have public insurance compared with nonhospitalized patients (64% vs. 41%; P < .001) and had a higher mean HbA1c (11% vs. 8.2%; P < .001). Hospitalized youths were also less likely to use an insulin pump compared with those who were not hospitalized (26% vs. 54%; P < .001) and less likely to use a continuous glucose monitor (39% vs. 75%; P < .001).

Most hospitalized patients admitted with DKA

DKA occurred in 16.5% of the entire study cohort and 72% of hospitalized patients. Of 44 youths with DKA, 38 had an HbA1c greater than 9%. Four were hospitalized with severe hypoglycemia, three received respiratory support, which includes two who received oxygen by nasal cannula and one who required mechanical ventilation. There were no deaths in the study cohort.

“The risk factors for DKA in children with type 1 diabetes during COVID-19 illness were the same risk factors that have been identified before the pandemic: higher HbA1c, minority race and ethnicity, public insurance, and lack of insulin pump and continuous glucose monitor use,” Alonso said. “We will need more research to compare people with diabetes with and without COVID-19 to identify how baseline blood sugar management affects the risk of getting COVID-19, to what extent having COVID-19 increases the risk of DKA, and how all the other pandemic-induced changes in daily life have affected the risk of DKA in this population.”

In fully adjusted data, a higher HbA1c was associated with an increased likelihood for COVID-19 hospitalization (adjusted OR = 1.56; 95% CI, 1.34-1.84; P < .001). Age, sex, insurance, and race and ethnicity were not associated with an increased hospitalization risk.

Alonso said providers at the Barbara Davis Center help families of children with type 1 diabetes prepare for illness by creating a sick day action plan with insulin dosing recommendations for elevated blood ketones and various hyperglycemia levels. However, he said, more research is needed to examine how type 1 diabetes specifically interacts with COVID-19.

“We need to identify better ways to help families navigate type 1 diabetes during illness,” Alonso said. “We also need to learn more about how having type 1 diabetes may modify long-term protection from COVID-19 after natural infection and vaccination, and how that may be further modified by blood sugar trends.”

For more information:

G. Todd Alonso, MD, can be reached at