Keep Calm: Under 25s With Diabetes Not Hospitalized Due to COVID-19

Becky McCall and Lisa Nainggolan

March 26, 2020

Reports from pediatric endocrinologists in COVID-19 hotspots globally indicate that children, adolescents, and young adults with diabetes have so far not shown a different disease pattern with the virus compared to children and younger people who do not have diabetes.

Indeed, colleagues in Wuhan, China, and Italy "state they have not had cases of COVID-19 in children, adolescents, or young adults < 25 years of age with diabetes who required hospitalization, to date [as of March 24]" according to a new statement from the International Society for Pediatric and Adolescent Diabetes (ISPAD).

ISPAD currently has about 1300 members around the globe and has instituted a discussion forum about the topic of treating children with both diabetes and COVID-19.

"We find these reports [from colleagues around the world], though anecdotal, to be reassuring," it notes. 

However, there are real worries regarding other potentially dangerous effects. ISPAD has expressed concern, for example, that the COVID-19 pandemic will prevent youngsters with existing diabetes who are having diabetic emergencies from seeking hospital care.

Chinese physicians have reported to ISPAD a number of cases of delayed hospital admissions for diabetic ketoacidosis (DKA) in children with known type 1 diabetes because hospital services were closed for non-COVID-19 care.

Andrea Scaramuzza, MD, a pediatric endocrinologist at Ospedale Maggiore di Cremona, Italy, has similarly reported multiple cases of patients presenting to emergency services there with severe DKA. 

"These experiences reinforce the importance of continued attentiveness to standard diabetes care to avoid the need for hospitalization and emergency or urgent care visits," says ISPAD, under the strapline: "Keep calm and mind your diabetes care."

But it nevertheless stresses that these resources should be used "if needed."

Worries That New-Onset Diabetes Will Be Missed During COVID-19

Scaramuzza told Medscape Medical News there are also concerns regarding delays in diagnoses of new cases of type 1 diabetes "due to the fear families have to go to the emergency department because of COVID-19."

Indeed, in Italy, a few patients have arrived with very serious DKA, he said. Scaramuzza noted a colleague from Naples, Dario Iafusco, MD, and his pediatric team have made a video to keep awareness high regarding new-onset diabetes.

"This coronavirus pandemic can be defeated if you stay at home, but if you know of a child who has excessive thirst, frequent urination, or who starts vomiting," seek healthcare advice immediately. "This child could have [type 1] diabetes. Prevent severe DKA, or worse, death," says Iafusco in the video.

Physicians from China have similar observations, reporting to ISPAD several cases of delayed admissions of newly diagnosed type 1 diabetes because hospital services were closed for non-COVID-19 care.

Keep Calm and Mind Your Diabetes Care; Physicians Use Telemedicine

Meanwhile, last week ISPAD issued guidance for young people with diabetes and their carers about what to do if COVID-19 infection is suspected.  

Most advice is the same as for the general public because reports of COVID-19 infection suggest it is much less severe in children and adolescents, and the summary currently serves "as reassurance that youth with diabetes are not more affected by COVID-19 than peers," it adds.

"Our approach to treating a child with diabetes would be to follow the ISPAD sick-day guidelines, which provide generalized diabetes management in any flu-like illness. We wouldn't do anything very different right now," one of the authors, Jamie Wood, MD, associate professor of clinical pediatrics at Case Western Reserve University, Cleveland, Ohio, told Medscape Medical News.

"Any illness makes diabetes more difficult to manage and can increase the risk of DKA," she emphasized.

"We would reinforce frequent monitoring of blood glucose and ketone levels, to never stop insulin — in fact, when most people are ill the body is stressed and requires more insulin — and to stay hydrated and treat the underlying symptoms."

And make sure to "treat the fever," she stressed. "When patients with type 1 diabetes get fever they have a tendency to make more ketones, so we recommend aggressive control of fever."

ISPAD recommends young people aim to keep blood glucose levels between 4 and 10 mmol/L (72 to 180 mg/dL) and blood ketones below 0.6 mmol/L (10.8 mg/dL) during illness, and to never stop insulin.

Guidance is provided on when to seek urgent specialist advice with possible referral to emergency care, for example, in cases where the patient has DKA symptoms, such as persistent and/or worsened fruity breath odor or vomiting.

Scaramuzza told Medscape Medical News that, in Italy, he and his colleagues have increased their use of telemedicine to keep monitoring their patients with diabetes even from a distance and that it was working very well.

"Technology such as downloading [records from] insulin pumps, continuous glucose monitoring systems, and the possibility to use Skype or other platforms really help," he noted.

"There has been a rapid increase in telehealth as a way to continue to care for youth with diabetes and decrease risk for infection," said ISPAD.

"Communication between patients, families, and healthcare teams is vitally important. Methods to do so that avoid visits to clinics or hospitals can provide needed diabetes advice and reduce risk for COVID-19 transmission."

ISPAD Summary. Published online March 25, 2020.

There were no relevant financial relationships.

Follow Lisa Nainggolan on Twitter: @lisanainggolan1. For more diabetes and endocrinology news, follow us on Twitter and Facebook.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.