American Diabetes Association
DKA_protocol_9-15-21.pdf (333.67 kB)

COVID-19 Exacerbates Insulin Resistance During Diabetic Ketoacidosis in Pediatric Patients with Type 1 Diabetes

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posted on 2022-08-09, 20:45 authored by Elizabeth S. Keiner, James C. Slaughter, Karishma A. Datye, Alan D. Cherrington, Daniel J. Moore, Justin M. Gregory

Objective: Although mortality from COVID-19 among youth with type 1 diabetes is rare, SARS-CoV-2 is associated with increased pediatric hospitalizations for diabetic ketoacidosis (DKA). To clarify whether the relationship between COVID-19 and DKA is coincidental or causal, we compared tissue glucose disposal (TGD) during standardized treatment for DKA between pediatric patients with COVID-19 versus those without COVID-19. 

Research Design and Methods: We retrospectively compared TGD during standardized therapy for DKA in all children with preexisting type 1 diabetes with or without COVID-19. Cases were assessed beginning with the first case of COVID-positive DKA on June 19, 2020 through February 2, 2022. 

Results: We identified 93 COVID-negative patients and 15 COVID-positive patients who were treated for DKA, with similar baseline characteristics between groups. Median TGD was 46% lower in patients who had COVID-19 compared to those that did not (p = 0.013).

Conclusions: These results suggest COVID-19 provokes a metabolic derangement over-and-above factors that typically contribute to pediatric DKA. These findings underscore the significant and direct threat posed by COVID-19 in pediatric type 1 diabetes and emphasize the importance of mitigation and monitoring including through vaccination as a primary prevention.


Research and personnel in this publication were supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers K23DK123392 (J.M.G.) and R01DK121316 (K.A.D.). The research was also supported by a pilot and feasibility grant from the Vanderbilt Diabetes Research and Training Center (DK020593). J.M.G was supported by a JDRF Career Development Award (5-ECR-2020-950-A-N). K.A.D. was supported by the Katherine Dodd Faculty Scholars Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the JDRF.