COVID-19 and Children With Diabetes—Updates, Unknowns, and Next Steps: First, Do No Extrapolation

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide pandemic has been devastating particularly for older adults and those from vulnerable groups, including racial and ethnic minority populations. Additionally, people with certain underlying medical conditions, including diabetes, are also at increased risk of severe illness from coronavirus disease 2019 (COVID-19) (1,2). Some children experience significant disease (3), and pediatric deaths have been reported (4). Because “diabetes” (generally grouping together type 1 diabetes and type 2 diabetes) and chronically elevated hyperglycemia have been associated with worse outcomes in adults with COVID-19 (5), the pediatric community has voiced great concerns about risk and outcomes for children with diabetes.A foundation of pediatrics is caution about the extrapolation of adult practice to children. Many publications report poor outcomes from COVID-19 and diabetes without emphasizing that data reported are from adults, frequently older adults with additional comorbidities. Moreover, there have been warnings related to COVID-19 and immunosuppression leading to confusion, predominately outside the medical community, about the difference between immunocompromised and autoimmune. In sum, these worries have led to increases in frequency and severity of diabetic ketoacidosis (DKA), due in part to families being reluctant to enter health care settings, especially in areas where COVID-19 cases cluster (6,7).Data scarcity regarding many aspects of how COVID-19 is affecting children with both new-onset and established diabetes has magnified these concerns. In this issue of Diabetes Care , Rabbone et al. (8) describe cross-sectional data from Italy, an early pandemic epicenter. This team examined diabetes diagnoses as well as reports of DKA and SARS-CoV-2 infection in children with new-onset and established type 1 diabetes from 20 February to 14 April 2020. They compare data on new presentations and DKA rates to data from the same period in 2019. They report …