What are the autoimmune-related complications of pediatric type 1 diabetes mellitus (DM), and what effect does type 1 diabetes mellitus have on complications of coronavirus disease 2019 (COVID-19)?

Updated: Mar 23, 2021
  • Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

Associated autoimmune diseases are common in type 1 diabetes mellitus, particularly in children who have HLA-DR3. Some conditions may precede the development of diabetes, and others may develop later. As many as 20% of children with diabetes have thyroid autoantibodies. [42]

Type 1 diabetes in pediatric patients has been linked to changes in cognition and brain structure, with a study by Siller et al finding lower volume in the left temporal-parietal-occipital cortex in young patients with type 1 diabetes than in controls. The study also indicated that in pediatric patients, higher severity of type 1 diabetes presentation correlates with greater structural differences in the brain at about 3 months following diagnosis. The investigators found that among study patients with type 1 diabetes, an association existed between the presence of diabetic ketoacidosis at presentation and reduced radial, axial, and mean diffusivity in the major white matter tracts on magnetic resonance imaging (MRI). In those with higher glycated hemoglobin (HbA1c) levels, hippocampal, thalamic, and cerebellar white matter volumes were lower, as was right posterior parietal cortical thickness, while right occipital cortical thickness was greater. Patients in the study were aged 7-17 years. [43]

A study by Dabelea et al found that in teenagers and young adults in whom diabetes mellitus had been diagnosed during childhood or adolescence, diabetes-related complications and comorbidities—including diabetic kidney disease, retinopathy, and peripheral neuropathy (but not arterial stiffness or hypertension)—were more prevalent in those with type 2 diabetes than in those with type 1 disease. [44]

COVID-19

A study indicated that children with type 1 diabetes mellitus who have an HbA1c level of 9% or above are at greater risk of mortality, intubation, and sepsis due to coronavirus disease 2019 (COVID-19) than are children without type 1 diabetes. However, the report also found evidence that such risk is not greater in children with an HbA1c level at or below 7%. The investigators found the COVID-19 mortality rates in children without type 1 diabetes, those with type 1 diabetes, and those with type 1 diabetes with an HbA1c of 7% or lower to be 0.047%, 0.328%, and 0%, respectively. [45]


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