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

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.

COVID-19 in two children with new-onset diabetes: case reports

“…The authors highlight that COVID-19 may have a potential diabetogenic effect in addition to the common illness stress response. 28 Our report also supports this finding. The hypothesis that the pleiotropic effects of SARS-CoV-2 on glucose metabolism may exceed the stress response related to symptoms and disease severity has also been stated by other authors.…”

“…A possible explanation may rely on the interaction between SARS-CoV-2 and the renin-angiotensin-aldosterone system. 28 Studies on the pathogenesis of glucose intolerance in patients with SARS-CoV-2 infection have uncovered that SARS-CoV-2 uses ACE2r as cellular entry point. The higher the level of expression ACE2 in the organs, the greater the level of damage by SARS-CoV-2.…”

Diabetic ketoacidosis and COVID-19: what have we learned so far?

“…Even though DKA occurs mainly in critical hospitalized patients resulting in worst outcomes, there are reports of it in patients with new-onset diabetes upon COVID infection. Chekhlabi and colleagues ( 28 ) reported two cases of children diagnosed with COVID-19 that developed symptoms suggestive of diabetic ketoacidosis upon hospital admission. One child presented with acidosis and urinary ketones and the other had fatigue, polydipsia, polyuria, and urine ketones.…”

“…The laboratories showed both hyperglycemia and HbA1c of 11.8% and 10.3%, respectively. They received intravenous rehydration followed by intravenous insulin therapy, which was subsequently replaced by subcutaneous insulin (as basal insulin) and Novorapid postmeal ( 28 ). Also, Reddy and colleagues ( 29 ) described two cases of adult patients that presented with hyperglycemia upon admission with no prior history of diabetes.…”

“…Chekhlabi and colleagues reported two cases of children diagnosed with COVID-19 that developed symptoms suggestive of diabetic ketoacidosis upon hospital admission [27]. One child presented with acidosis and urinary ketones and the other had fatigue, polydipsia, polyuria and urine ketones.…”