New Coronavirus Infection as One of The Factors in The Development of Type 1 Diabetes Mellitus in Children

Research Article | DOI: https://doi.org/10.31579/2768-2757/162

New Coronavirus Infection as One of The Factors in The Development of Type 1 Diabetes Mellitus in Children

  • Ermachenko M.F 1-2*
  • Ivanov RA 1
  • Popelkov AA 1
  • Nomokonov VI 1
  • Pavlyuk RP 1
  • Klimova OS 1
  • Sergeeva LI 1
  • Anisimova AF 1
  • Gvak GV 3-4

1OGBUZ "Bratsk Children's City Hospital", Irkutsk region, Bratsk.

2Irkutsk State Medical University, Irkutsk region, Irkutsk.

3State Budgetary Healthcare Institution “Irkutsk State Regional Children’s Clinical Hospital”, Irkutsk Region, Irkutsk.

4 Irkutsk State Medical Academy of Postgraduate Education, branch of RMAPO, Irkutsk Region, Irkutsk. 

*Corresponding Author: Ermachenko M.F., OGBUZ

Citation: Ermachenko M.F., Ivanov RA., Popelkov AA., Nomokonov VI., Pavlyuk RP., et al, (2025), New Coronavirus Infection as One of The Factors in The Development of Type 1 Diabetes Mellitus in Children, Journal of Clinical Surgery and Research, 5(6); DOI:10.31579/2768-2757/162

Copyright: © 2025, Ermachenko M.F. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 03 February 2025 | Accepted: 19 February 2025 | Published: 24 February 2025

Keywords: diabetes; covid-19; children

Abstract

Interaction with district pediatricians and a social worker revealed that most children with repeated hospitalizations to the intensive care unit were brought up in asocial families (drinking or drug-addicted parents). The children were not given due attention, there was a violation of diet and insulin intake, which eventually led to the development of a coma. Emergency notifications about "abuse syndrome" were sent to the parents of these children.

Introduction

At the time of writing (30.01.2025), 102,607,583 people in the world fell ill with the new coronavirus infection. Since the beginning of the pandemic, the mortality rate was 2.15% (2,214,783 people died). In Russia, since the beginning of the pandemic, 24,877,276 people fell ill, of which 403,360 died, the mortality rate is 1.62% [4]. In different countries, the number of sick children from newborns to 18 years of age ranges from 0.8 to 2.8% [1,2,3,4]. During the COVID-19 pandemic, many large studies have confirmed a direct relationship between the severity of the infectious disease and a history of diabetes. A meta-analysis of 8 studies involving almost 50,000 patients with COVID-19 showed that diabetes mellitus (DM) is the second most common comorbidity after hypertension [5].

According to experts, the high risk of developing infection in patients with diabetes is explained by immune disorders due to hyperglycemia and its acute and chronic consequences. In addition, elevated cytokine levels increase the risk of developing a severe form of infection [6]. Studies by Chinese scientists have found that diabetes mellitus is more common among patients with severe COVID-19 than among patients with a mild form of the disease: 16.2% versus 5.7%, and the prognosis for COV ID-19 in patients with diabetes was worse [7].

According to a number of studies, diabetes is also a risk factor for mortality in patients with COVID-19. A large national sample study showed that the mortality rate of patients with diabetes was significantly higher than that of patients without it: 10% versus 2.5% [6]. The mortality rate of patients without comorbid conditions in China was 0.9%, while in patients with diabetes it reached 7.3% [9]. A study of the clinical characteristics of deaths with COVID-19 revealed that diabetic ketoacidosis is one of the causes of patient mortality [9]. Diabetes mellitus (DM) is a risk factor for the development of severe pneumonia and septic course of viral infection, associated with the development of multiple organ failure and an increased risk of complications and death [8,9].

We noticed that in the city of Bratsk in the period 2019-2024 the number of sick children with newly diagnosed type 1 diabetes increased sharply. During the same period, outbreaks in the form of a pandemic of a new coronavirus infection were observed around the world. We decided to trace the connection between newly diagnosed diabetes and a previous illness of a new coronavirus infection. Many scientists are inclined to believe that COVID -19 attacks the cells of the pancreas, as a result of which it stops producing insulin in the required quantities. Under the influence of the corona virus, the body produces proteins whose work is called the "abnormal immune response." The body fights itself. The COVID-19 virus affects the b-cells of the pancreas, its tissue is a potential target for infection, leading to glucose metabolism disorders. This means that it can trigger the development of type 1 diabetes or cause an increase in sugar levels (decompensation of diabetes if present). It is assumed that the SARS-CoV-2 virus seriously damages the islet cells of the pancreas and contributes to the development of diabetes or its worsening. [9,10,11]

Purpose Of the Study

To analyze the reasons for the increase in the number of patients with newly diagnosed type 1 diabetes mellitus, as well as repeated admissions of such patients with a previously established diagnosis to the anesthesiology and intensive care unit in normal years and during the pandemic of a new coronavirus infection. To trace the possible relationship between a history of a new coronavirus infection and the development of type 1 diabetes mellitus in children.

Methods And Materials

In the intensive care unit of the OGBUZ "Bratsk Children's City Hospital" for 25 years, in the period from 2000 to 2024, 340 cases of sick children with the diagnosis of: Type 1 diabetes mellitus (DM type 1) aged from 1 year to 18 years were hospitalized. In 321 cases, the diagnosis upon admission was: type 1 diabetes mellitus, diabetic precoma or coma, ketoacidosis and in 19 cases the diagnosis was: type 1 diabetes, hypoglycemic coma. Of the 340 cases of hospitalization: in 138 cases, DM type 1 was diagnosed in children for the first time, and in 202 cases there were repeated hospitalizations.

Research Results

 

Total number of patients in intensive care, number of patients with diabetes

(abs., %)

Number of hospitalizations of diabetes mellitus newly diagnosed

(abs.)

Number of cases of rehospitalization of diabetes

(abs.)

2000285; 7 (2.5%)25
2001279; 3 (1.1%)12
2002290; 7 (2.4%)34
2003184; 4 (2.2%)22
2004291; 6 (2.1%)15
2005296; 4 (1.4%)22
2006344; 4 (1.2%)22
2007345; 2 (0,6%)11
2008405; 3 (0,7%)21
2009323; 4 (1,2%)31
2010305; 9 (3,0%)72
2011254; 5 (2,0%)32
2012252; 6 (2,4%)15
2013254; 12 (4,7%)57
2014243;11 (4,5%)29
2015206;17 (8,3%)710
2016284; 12 (4,2%)210
2017300; 16 (5,3%)79
2018260; 26 (10,0%)818
2019294; 28 (9,5%)820
2020220; 22 (10,0%)1012
2021228; 36 (15,7%)1620
2022273; 41 (15,0%)1724
2023226; 24 (10.7%)1212
2024203; 31 (15.3%)1417
Total:6470; 340 (5.4)138202

Table 1: The absolute and relative number of patients with type I diabetes treated in the intensive care unit is presented in.

Table 1 type I diabetes in the intensive care unit in comparison with the total number of ICU patients abs., (%).

Diagram 1: Cases of hospitalization of patients with type I diabetes (primary/recurrent) years.

Comparative diagram by year of hospitalizations of patients with the diagnosis: Newly diagnosed type I diabetes and re-hospitalized patients with the established diagnosis: type I diabetes (abs.).

Note: patients who were readmitted with a diagnosis of type 1 diabetes are marked in red; patients with a diagnosis of type 1 diabetes, newly diagnosed, are marked in blue.

When analyzing Table 1 and Diagram 1, it was revealed that starting in 2020, the number of patients with newly diagnosed type 1 diabetes mellitus has increased significantly. Over 20 years (2000–2019), the increase in patients with newly diagnosed type 1 diabetes mellitus ranged from 1–8 patients per year (an average of 4 people/year). However, starting in 2020, during the “covid” years, the number of patients with newly diagnosed type 1 diabetes mellitus has increased sharply. The increase in patients in this group ranged from 10–17 patients (an average of 14 people/year). The number of re-hospitalizations with diabetes mellitus over 20 years (2000–2019) ranged from 1–20 cases (an average of 6 cases/year). For the period from 2020–2024. from 12 to 24 cases of re-hospitalization per year (on average 19 cases/year).

Reasons for hospitalization of patients with diabetes in intensive care units
Reasons for hospitalizationNumber of cases, abs. (%)
Initial hospitalization: 
newly diagnosed diabetes138 (40.6%)
Rehospitalization: 
diet violation85(25.1%)
untimely insulin injection46(13.5%)
concomitant diseases71(20.8%)
Total:340 (100%)

Table 2: Reasons for hospitalization of patients with type I diabetes in intensive care units.

Table 2 shows that the main reason for hospitalization of patients with type I diabetes in the intensive care unit is newly diagnosed type I diabetes with the development of precoma or coma - 138 patients (40.6%). Among repeated hospitalizations to the intensive care unit, dietary violation in patients with type I diabetes was 85 (25.1%), of which 75 patients (88.2%) led to the development of diabetic coma. The history of the development of the disease in these children includes the use of carbohydrates in the form of chocolate, sweets, carbonated drinks . And in 10 patients (11.8%), untimely food intake against the background of insulin injection led to the development of hypoglycemic coma . In 46 patients (13.5%), independent cancellation of insulin led to the development of diabetic coma. In 71 patients (20.8%), concomitant diseases (ARI, flu, pneumonia, covid-19) led to a "breakdown" of compensatory mechanisms against the background of selected insulin therapy and the development of diabetic coma. Our analysis showed that several patients were regularly admitted to the intensive care unit with signs of coma for several years. Over twenty-five years of observation, 19 patients moved to other cities for permanent residence. 29 patients were removed from "D" registration in 

the children's clinic due to them reaching 18 years of age and switching to "D" registration in adult clinics. Interaction with district pediatricians and a social worker revealed that most children with repeated hospitalizations to the intensive care unit were brought up in asocial families (drinking or drug-addicted parents). The children were not given due attention, there was a violation of diet and insulin intake, which eventually led to the development of a coma. Emergency notifications about "abuse syndrome" were sent to the parents of these children.

When a patient with suspected diabetes is admitted to the emergency room, the patient is examined by a pediatrician, endocrinologist and resuscitator, a blood sugar test is taken according to cito . Since 2020, a PCR swab for covid-19 or an express test for covid-19 is additionally taken in the emergency room to determine the profile of the department for hospitalizing patients.

Of the 138 patients admitted to the intensive care unit with newly diagnosed diabetes mellitus and in 202 cases in patients with rehospitalization, there were manifestations of diabetic precoma or coma, as well as signs of severe metabolic acidosis.

Year

 

Total number of patients with newly diagnosed diabetes and number of patients who underwent ELISA blood testing for immunoglobulins to SARS-CoV-2

Ig M

CP <0>

CP from >=0.8 to <1>

CP>=1.1 – positive and number of patients (abs. and %)

Ig G

<10>

>=10 – positive

(Min – max values) and number of patients (abs. and %)

202010(4; 40.0%)neg.16.49 – 716.46 (4)
202116(8; 50.0%)1.92 – 3.94 (2)29.08 – 689.79 (6)
202217(10; 58.8)4.15 (1)28.76- 449.61 (9)
202312(5;41.6%)neg.15.38 – 790.79 (5)
202414(8;57.1%)1.26 – 2.98 (1)12.45 – 890.35 (7)
Total:69(35; 49,5%)4 (5,8%)31 (44,9%)

Table 3: Number of patients with newly diagnosed diabetes Type I, who underwent ELISA blood testing for immunoglobulins to SARS-CoV-2.

From 2020 to 2024, all patients diagnosed with type I diabetes mellitus underwent PCR testing for SARS-CoV-2 in the emergency department. Detection of antibodies to SARS-CoV-2 is of auxiliary importance for diagnosis of current infection and is essential for assessing the immune response to the current or a previous infection. Solution about testing for antibodies to SARS-CoV-2 was decided by the attending physician individually, based on clinical appropriateness (on average, ELISA blood test for immunoglobulins to SARS-CoV-2, performed in 11.2% of cases in 35 patients). For the period from 2020 to 2024, out of 69 patients with newly diagnosed diabetes, Type I in 14 patients (20.2%), a positive nasopharyngeal swab for PCR analysis for SARS-CoV-2 was noted. And in 35 patients who, as prescribed by a doctor, were tested for antibodies to SARS-CoV-2, a positive Ig test was noted in 4 patients (11.4%). M to SARS-CoV-2 and 31 patients (88.6%) had a positive Ig test G  to SARS-CoV-2. Two patients tested positive for Ig M to SARS-CoV-2 and Ig G  to SARS-CoV-2. Thus, the analysis of Table 3 shows that mild, moderate or severe COVID-19 infection in children served as a provoking factor in the development of type I diabetes in children in different age groups. Moreover, in some patients, the development of diabetes mellitus occurred in the acute stage of covid-19 (14 patients had a positive PCR test for SARS-CoV-2). In 4 patients, type I diabetes developed in the period from 7 days to 2 months after suffering from covid-19 (this is indicated by an elevated level of Ig M to SARS-CoV-2). In 31 patients, diabetes mellitus developed from 3 weeks to several months after the new coronavirus infection (this is evidenced by an increased level of Ig G  to SARS-CoV-2).

Conclusions:

  1. Based on positive PCR tests for SARS-CoV-2, some patients with type I diabetes also have positive tests for Ig antibodies M And Ig G  to SARS-CoV-2, as well as a significant increase in patients with newly diagnosed type 1 diabetes during the COVID-19 pandemic (in 2020-2024, an average of 14 cases/year and in non-COVID years, an average of 4 cases/year), it can be concluded that the pancreas is a target organ for the SARS-CoV-2 virus. Damage to pancreatic tissue by the virus and toxins contributes to the development of type 1 diabetes in children of different age groups. A final determination of the relationship between the SARS-CoV-2 virus and the development of type 1 diabetes in children requires additional clinical observation and research.
  2. diabetes has increased threefold (in 2020-2024, an average of 19 cases/year and in non-COVID years, an average of 6 cases/year), which is associated with the worsening of the course of diabetes mellitus against the background of patients with a new coronavirus infection.

References

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Luiz Sellmann

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina