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Type 1 diabetes increases the risk of COVID-19 in children when A1c is high

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New data on the risk of COVID-19 in children Type 1 diabetes It not only gives you peace of mind, but also emphasizes the importance of effective glycemic control.

Results from more than 3,000 and more than 500,000 children with type 1 diabetes show mortality, intubation, and Sepsis For COVID-19, in patients with type 1 diabetes A1c Level ≤ 7%.

However, the proportion of these COVID-19 results was significantly higher among children with type 1 diabetes who had A1c levels above 9%.

The findings of these children are similar to some Previous research In the whole and adult type 1 diabetic population analysis From UK Biobank early in the pandemic.

“It is very important to properly manage blood glucose levels during the COVID-19 pandemic to prevent hospitalization and death in children with type 1 diabetes,” he said in an analysis from a large global database. Manish Raisingani, MD, said. TriNetX Virtually Endo 2021 Meeting.

He added that the data can help inform decisions about whether it is safe to send children with type 1 diabetes directly to the classroom.

“If A1c is less than 7%, serious complications from COVID-19 may not occur as long as precautions such as masking and social distance are taken … while A1c exceeds 9%. If [it’s] It’s best to have a virtual school during these times, “said Raisingani, a children’s endocrinologist at the Arkansas Children’s Hospital in Little Rock.

Asked for comment, Dr. Robert W. Rush, MD, Chief Expert and Chief of Clinical Affairs of the Endocrine Society, said: Medscape Medical News He generally agrees with Raisingani’s conclusions and advice.

However, he warned against focusing on relative risk increases rather than overall fairly small absolute risk increases.

“Even the death of one person is tragic, [one] Too many, but focusing on relative risk scares people’s Bejesas, “Rush commented.

According to Rush, the data show that “if your child has diabetes and is suffering from it, school is probably not the best place for them.”

On the other hand, “If your child has diabetes and takes good care of it, he is not a walking COVID-19 time bomb.”

A1c Matters of COVID-19 Risk in Children with Type 1 Diabetes

Raisingani et al. Analyzed data from TriNetX, a large COVID-19 database that collects real-time electronic medical record data from 60 medical institutions around the world.

They compared 3047 children aged 0-18 years with type 1 diabetes with 502,655 children without type 1 diabetes, and also examined a subset of 482 children with type 1 diabetes with A1c of 7% or less. ..

There were no deaths in the 235 non-diabetes group, 10 in the type 1 diabetes group, and in the type 1 diabetes and A1c ≤ 7% groups, corresponding to 0.047%, 0.328%, and 0 mortality rates, respectively.

The relative risk of death for the entire group of children with type 1 diabetes was 7.04 compared to the non-diabetic group ()P <.0001).

In contrast, P The value in the A1c ≤ 7% group was not significant compared to the non-diabetes group (P = 0.6349).

“If type 1 diabetes is well managed, the risk of dying from COVID-19 is very low, much like the average person,” says Raisingani.

Similarly, for sepsis, the number of patients without type 1 diabetes, all patients with type 1 diabetes, and the A1c ≤ 7% subgroup are 575, 15, and 0, respectively, and the risk percentages are 0.114, 0.492. , And 0.

Again, the overall relative risk of type 1 diabetes was significantly higher by 4.3 times (P <0.0001), but not significantly in patients with A1c ≤ 7% (<0.0001)P = .79).

Finally, endotracheal intubation was required for non-diabetes, type 1 diabetes, and 142, 10, and 0 children in the A1c ≤ 7% group, with risk rates of 0.028, 0.328, and 0, respectively. The relative risk for the entire type 1 diabetes group was 11.65 (P <.001).

In discussions, Raisingani said the same risks were seen after adjusting for factors such as age and gender, but not all confounding factor information was available from all contribution centers.

Nevertheless, he said, “when A1c goes from 9% to 10%, the risk increases exponentially.”

Raisingani and Lash No relevant financial relationships have been reported.

ENDO2021. Summary OR23-3. Announced on March 20, 2021.

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