Paediatric adrenal insufficiency, T1D may impact COVID-19 outcomes

Children who have adrenal insufficiency or type 1 diabetes (T1D) may have a higher likelihood of mortality and certain complications of COVID-19, according to research presented at ENDO 2021.

The researchers used electronic medical records from the TriNetX database which has data from 54 healthcare organizations to identify children (age ≤18 years) with and without adrenal insufficiency (n=1,311 and 537,807, respectively) who were diagnosed with COVID-19. 

Children with COVID-19 who had adrenal insufficiency had a higher risk of mortality than those with COVID-19 without adrenal insufficiency (0.92 percent vs 0.032 percent; relative risk [RR], 28.9; p<0.0001). [ENDO 2021, abstract P35-11]

Children with COVID-19 and adrenal insufficiency also had an elevated risk of sepsis than those without adrenal insufficiency (3.05 percent vs 0.1 percent; RR, 32.9; p<0.0001), as well as a higher likelihood of requiring endotracheal intubation (0.92 percent vs 0.019 percent; RR, 48; p<0.0001).

“Adrenal insufficiency may put a person at higher risk of infections due to a lack of normal stress response by the body,” said lead researcher Dr Manish Raisingani from the University of Arkansas for Medical Sciences and Arkansas Children’s in Little Rock, Arkansas, US. “Until now, there has been limited data on children with adrenal insufficiency and COVID-19,” he said.

In this study, children with adrenal insufficiency who were diagnosed with COVID-19 had a higher risk of death, sepsis, and endotracheal intubation compared with children with COVID-19 who did not have adrenal insufficiency, he continued.

However, Raisingani acknowledged the difficulty in distinguishing between pre-existing adrenal insufficiency and that which occurred due to COVID-19. He advocated for further research with larger sample sizes to examine complications of COVID-19 in patients with adrenal insufficiency. 

The impact of T1D and glucose control on COVID-19 complications

In a separate study, the same database was used to identify children with and without T1D (n=1,618 and 251,517, respectively) diagnosed with COVID-19.

Among children with COVID-19, those with T1D had a higher mortality rate than those without T1D (0.618 percent vs 0.102 percent; RR, 6.05; p<0.0001). [ENDO 2021, abstract OR23-3]

Those with COVID-19 and T1D also had a higher risk of septic shock than those with COVID-19 without T1D (1.05 percent vs 0.293 percent; RR, 3.59; p<0.00001), and were more likely to require endotracheal intubation (0.618 percent vs 0.071 percent; RR, 8.73; p<0.0001).

When glucose control was considered, children with HbA_1c levels >9 percent had a tenfold risk of COVID-19 complications compared with those whose HbA_1c levels were ≤7 percent.

“[K]eeping diabetic children’s blood sugar under control is more important than ever during the pandemic,” said Raisingani.

“Many parents of children with T1D are wondering if it’s safe to send their child to school during the pandemic,” he continued. “Our findings indicate that if their HbA_1c is high, it would be best to have them attend virtual school, but if it’s 7 percent or under, their risk is similar to other children without T1D.”

“The findings will help children with T1D and their families make better choices about the safety of attending school in person and engaging in other in-person activities during this pandemic,” he concluded.