The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19

Modarelli, Rachel; Balikcioglu, Pinar Gumus; Hendrix, Grace; DeRusso, Michelle; Ozment, Caroline

doi:10.1016/j.aace.2021.05.007

Cited by 4 publications

(8 citation statements)

References 13 publications

(17 reference statements)

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“…The test came out positive in this patient, suggesting the patient had an antibody to COVID-19 and DKA happened alongside COVID-19. 19 Another case study explained COVID-19 pathophysiology and its correlation to DKA. As generally known, SARS-CoV2 bonded with angiotensin-converting enzyme 2 (ACE2) to enter the cells.…”

Section: Discussionmentioning

confidence: 99%

“…As generally known, SARS-CoV2 bonded with angiotensin-converting enzyme 2 (ACE2) to enter the cells. 19 Those receptors converted angiotensin-2 to angiotensin, that reduced inflammation and increased insulin production. 19 Other than the respiratory tract, ACE2 receptors were also found in the gastrointestinal tract and pancreas, suggesting that SARS CoV-2 bind to the receptor, causing downregulation of ACE2 receptors in the pancreas and disrupting ß cells.…”

Section: Discussionmentioning

confidence: 99%

“…19 Those receptors converted angiotensin-2 to angiotensin, that reduced inflammation and increased insulin production. 19 Other than the respiratory tract, ACE2 receptors were also found in the gastrointestinal tract and pancreas, suggesting that SARS CoV-2 bind to the receptor, causing downregulation of ACE2 receptors in the pancreas and disrupting ß cells. 19 The downregulation of these receptors also caused the accumulation of angiotensin-2, which contributed to insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

“…19 Other than the respiratory tract, ACE2 receptors were also found in the gastrointestinal tract and pancreas, suggesting that SARS CoV-2 bind to the receptor, causing downregulation of ACE2 receptors in the pancreas and disrupting ß cells. 19 The downregulation of these receptors also caused the accumulation of angiotensin-2, which contributed to insulin resistance. This mechanism is suspected of having DM type 1 in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

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First onset of diabetic ketoacidosis in teenagers with COVID-19: a case report from a limited health care setting

Hsieh¹,

Eric²,

Tangkau³

et al. 2022

Bali Med J.

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Background: Diabetic ketoacidosis (DKA) has been well-known as the main complication that is a potentially fatal emergency in some teenagers with type 1 diabetes mellitus (DM). Although children with diabetes are not at high risk for severe COVID-19 infection, it can hypothetically lead to type 1 DM and severe DKA. The aim of this article is to briefly discuss a case of a teenager with DKA and COVID-19. Case: A 13 years old girl came in with abdominal pain, nausea, vomiting and dyspnea. She was alert but weak. Her blood pressure was 100/70 mmHg with 120 pulses and 35 breaths per minute. Oxygen saturation was at 99%. History of previous illness was denied. She was treated using a dyspepsia algorithm while waiting for the laboratory result. Later on, the test showed conditions of hyperglycemia, severe acidosis, ketonuria and a positive rapid COVID–19 antibody test. Hence, a diagnosis of DKA with probable COVID–19 was made and PCR for confirmation of COVID-19 diagnosis was scheduled. Oxygen support, rehydration, and insulin therapy were also given with a precautionary condition of possible COVID–19. In minutes, she developed respiratory distress that led her to be intubated and put on a ventilator. Due to a lack of facilities, a referral to a higher-level hospital was needed. However, since the referral process for probable COVID-19 patients required a long preparation, the patient died during the process. Conclusion: Besides early diagnosis and prompt treatment, a well-coordinated referral system is crucial in managing DKA patients with possible COVID–19.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

First onset of diabetic ketoacidosis in teenagers with COVID-19: a case report from a limited health care setting

Hsieh¹,

Eric²,

Tangkau³

et al. 2022

Bali Med J.

View full text Add to dashboard Cite

show abstract

“…In addition, a β-cell transdifferentiation path was identified: the infection caused a reduction of insulin content and secretion along with a reduction in protein processing and expression [ 74 ]. Creating this hyperinflammatory state, COVID-19 may easily induce ketosis and ketoacidosis [ 57 , 75 ]. Case reports and studies, lastly, described the development of necrotic and non-necrotic pancreatitis, and elevations in lipase and amylase during and following the infection [ 67 , 76 ].…”

Section: Covid-19 and Pathogenetic Mechanisms Of β-Cell Destructionmentioning

confidence: 99%

COVID-19 and diabetes in children

Prosperi

Chiarelli

2022

Ann Pediatr Endocrinol Metab

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This review describes the impact of coronavirus disease 2019 (COVID-19) in children and adolescents, investigating changes in diabetes presentation during the COVID-19 pandemic, possible links between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and diabetes, and mechanisms of pancreatic β-cell destruction. Although glycemic control in individuals with already known diabetes mellitus did not worsen during the pandemic, there was a worrying increase in diabetic ketoacidosis in children with new-onset diabetes, probably due to containment measures and delayed access to emergency departments. Moreover, new evidence suggests that SARS-CoV-2 has the capacity to directly and indirectly induce pancreatic β-cell destruction, and the risk of newly diagnosed diabetes after COVID-19 increased in both children and adults. While long-term studies continue to follow children with SARS-CoV-2 infection, this review discusses available findings on the relationship between COVID-19 and diabetes. It is important to emphasize the need to maintain close links between families of children with chronic conditions and their pediatricians, as well as to promote early access to healthcare services, in order to reduce dangerous delays in diabetes diagnosis and prevent diabetic ketoacidosis.

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Pediatric Diabetes on the Rise: Trends in Incident Diabetes During the COVID-19 Pandemic

Modarelli

Sarah

Ramaker

et al. 2022

Journal of the Endocrine Society

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Context The effects of the COVID-19 pandemic on the incident cases of pediatric Type 1 (T1D) and Type 2 diabetes (T2D) are not clear. Objective To identify trends in incidence and presentation of pediatric new-onset T1D and T2D during the COVID-19 pandemic. Methods A retrospective chart review was conducted. Demographics, anthropometrics, and initial labs from patients ages 0-21 who presented with new-onset diabetes to a pediatric tertiary care center were recorded. Results During the pandemic incident cases of pediatric T1D increased from 31 in each of the prior two years to 46; an increase of 48%. Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The number of incident cases of pediatric T2D increased significantly more than the number of incident cases of pediatric T1D (p-value = 0.009). Patients with T2D were more likely to present in DKA, though this was not statistically significant (p-value=0.093). Severe DKA was higher compared to moderate DKA (p-value = 0.036) in incident cases of pediatric T2D. During the pandemic, for the first time, incident cases of T2D accounted for more than half of the all newly diagnosed pediatric diabetes cases (53%). Conclusions There were more incident pediatric T1D and T2D cases as well as an increase in DKA severity in T2D at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the pediatric diabetes trends with profound individual and community health consequences.

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The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19

Cited by 4 publications

References 13 publications

First onset of diabetic ketoacidosis in teenagers with COVID-19: a case report from a limited health care setting

First onset of diabetic ketoacidosis in teenagers with COVID-19: a case report from a limited health care setting

COVID-19 and diabetes in children

Pediatric Diabetes on the Rise: Trends in Incident Diabetes During the COVID-19 Pandemic

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