BREAKING COVID-19 News! SARS-CoV-2 Is Causing New Onset Of Diabetes Mellitus Even In Babies A Few Months Old!

COVID-19 News: In a shocking development, the Department of Pediatrics at Akron Children's Hospital in Ohio, USA, has reported an alarming increase in the incidence of Type 1 Diabetes Mellitus (T1DM) in young children, even those as young as a few months old. The surge in cases is believed to be linked to the ongoing COVID-19 pandemic, revealing a concerning correlation between SARS-CoV-2 infection and the onset of diabetes. This COVID-19 News report delves into the unprecedented case of a 5-month-old infant who was diagnosed with T1DM in the midst of a COVID-19 infection, shedding light on the potential implications of this emerging trend.


Even babies are developing diabetes as a result of SARS-CoV-2
 
Rising Incidence of Type 1 Diabetes Mellitus
Traditionally, T1DM has been recognized as an autoimmune disorder that predominantly affects children and adolescents, with the incidence peaking during school age and early adolescence. However, recent years have witnessed a 3% overall increase in the diagnosis of T1DM, and since the advent of the COVID-19 pandemic, there have been reports indicating a staggering 33% to 166% rise in its incidence. This surge is particularly alarming as T1DM is typically considered rare in infants, with neonatal diabetes mellitus (NDM) being a more likely cause before six months of age.
 
COVID-19's Impact on T1DM Incidence
The novel coronavirus, SARS-CoV-2, primarily known for causing respiratory symptoms, has now been implicated in the surge of T1DM cases. The virus enters cells through glycosylated proteins binding to angiotensin-converting enzyme-2 (ACE2) receptors. Notably, the pancreas has high levels of ACE2 expression, potentially leading to acute pancreatic injury and subsequent damage to beta cells, resulting in hyperglycemia. The evidence of increased T1DM diagnoses and the severity of associated conditions, such as diabetic ketoacidosis (DKA), has been noted since the onset of the COVID-19 pandemic.
 
Case Report: The Youngest Reported T1DM Case with COVID-19
A significant case study presented in this article involves a 5-month-old infant who, despite having no significant past medical history, was diagnosed with T1DM during a concurrent COVID-19 infection. The infant's initial presentation included Kussmaul respirations, altered mental status, weight loss, increased appetite, and signs of respiratory distress. Laboratory results confirmed hyperglycemia, severe acidosis, and elevated beta-hydroxybutyrate levels, indicative of DKA. Importantly, a positive result for SARS-CoV-2 infection was obtained through a respiratory film array.
 
Management of T1DM in Infants
Managing T1DM in infants presents unique challenges, not only due to glycemic variability but also the potential for developmental delays. This case involved the administration of normal saline boluses, isotonic IV fluids, and initiation of insulin therapy. The infant was eventually transitioned to an insulin pump and continuous glucose monitor to ensure precise glycemi c control. Post-discharge, the child underwent physical therapy for gross motor delays, highlighting the broader impact of T1DM in this age group.
 
Exploring Genetic Factors and Autoimmunity
The case study considered genetic factors by conducting an Invitae Monogenic Diabetes Panel, which turned out negative. Despite the infant's young age, a positive insulin antibody and family history of T1DM pointed towards an autoimmune etiology. The link between T1DM and other autoimmune disorders, such as Hashimoto's thyroiditis, was also observed. The study cum case report emphasizes the increased risk of T1DM development in individuals with a family history, underlining the importance of genetic predisposition.
 
Role of Breastfeeding and Viral Triggers
Breastfeeding was noted as a potential protective factor against the development of T1DM. However, the increasing incidence of T1DM in infants, particularly during the COVID-19 era, suggests a complex interplay between genetic predisposition, viral triggers, and potential protective factors. Previous associations between T1DM and viral infections, including enteroviruses, rubella, mumps, parainfluenza, cytomegalovirus, and human herpesvirus-6, were explored, indicating a need for further research into the acute phase of beta cell destruction in T1DM.
 
COVID-19's Direct Impact on Beta Cells
The novel coronavirus's direct impact on beta cells was explored, with the virus binding to ACE2 receptors expressed in pancreatic endocrine cells. This interaction may lead to acute injury and destruction of beta cells, contributing to the observed increase in T1DM cases during the COVID-19 pandemic. The researchers call for more extensive research to understand the intricate relationship between COVID-19, autoimmunity, and beta cell function.
 
Rise in Diabetic Ketoacidosis and its Implications
The study also addresses the concurrent increase in diabetic ketoacidosis (DKA) cases since the onset of the COVID-19 pandemic. Studies have indicated a more than twofold rise in DKA in children with new onset T1DM from 2019 to 2020. Factors contributing to this increase include a potential delay in seeking medical care during the early stages of the pandemic and the direct impact of COVID-19 on beta cells, leading to acute loss of function and severe DKA. The complexity of diagnosing diabetes in infants, especially during respiratory viral infections, is discussed.
 
Developmental Delays and Cognitive Implications
Notably, infants diagnosed with T1DM, especially those with early onset, face a higher risk of developmental delays and lower cognitive function. The severe episodes of DKA and glycemic variability pose a threat to the developing brain, leading to concerns about long-term cognitive outcomes. The case report references studies indicating a higher prevalence of developmental, learning, and language disorders in individuals with diabetes. The case study in question reported motor delays, highlighting the need for continuous monitoring of developmental milestones in this vulnerable population.
 
Conclusion
In conclusion, the documented case of a 5-month-old infant with antibody-positive T1DM and COVID-19 infection signifies a troubling trend in the increasing incidence of diabetes, particularly in the younger population. The interplay between genetic predisposition, viral triggers, and potential protective factors, such as breastfeeding, requires further exploration. The study emphasizes the importance of ongoing research to comprehend the complex relationship between COVID-19, autoimmunity, and the direct impact on beta cells. Additionally, the surge in diabetic ketoacidosis cases and the potential long-term cognitive implications highlight the urgent need for enhanced awareness, early diagnosis, and comprehensive management of T1DM in infants and young children, especially in the post-COVID-19 era.
 
The case report cum study was published in the peer reviewed journal: Clinical Pediatrics. (Sage Journals).
https://journals.sagepub.com/doi/full/10.1177/00099228231224845
 
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