A SURGE OF TYPE 1 DIABETES MELLITUS AMONG NIGERIAN CHILDRENDURING THE COVID-19 PANDEMIC

C.A. Nri-Ezedi1 , T.O. Ulasi1 , K.N. Okeke1, I.T. Okonkwo2, S.T. Echendu2, N.V. Agu2, E.I. Nwaneli1

  1. Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria..
  2. Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.

Abstract

Background: A substantial increase in Type 1 Diabetes Mellitus (T1DM) has been reported globally among children following the discovery of COVID-19. This study reports a similar trend among Nigerian children.

Method: A twelve-year (2010-2021) retrospective review of T1DM cases admitted in the Paediatric wing of a tertiary hospital in South-East Nigeria.

Result: During the twelve-year study, 21 T1DM patients were seen: 9 (43%) males and 12 (57%) females. Approximately 60% of these cases presented during the pandemic (2020-2021). The mean age of subjects with T1DMwas 10.5 ± 4.1 years, with females being slightly older than the male subjects (11.6 ± 3.7 years vs 9.2 ± 4.3 years respectively; p=0.176). Prior to the pandemic, females were significantly older than males (11.6 ± 3.7 years vs 4.5 ± 2.1 years respectively; p=0.042), but no age difference was observed during the pandemic (11.6 ± 4.1 years vs 10.4 ± 3.9 years respectively; p=0.597). 80% of all males in this study were seen during the pandemic and were older than the males seen before the pandemic (10.4 ± 3.9 years vs 4.5 ± 2.1 years; p=0.078). Following adjustments for age and gender, older children and males had an increased odd of developing T1DM during the pandemic but this was not statistically significant.

Conclusion: This study highlights the need for increased awareness and high index of suspicion of T1DM among children during this pandemic. In the interim, more robust multi-centre studies are required to investigate the underlying relationship between COVID-19 and T1DM.

Keywords: Type 1 Diabetes Mellitus, Covid-19, Pandemic, Coronavirus, Glucose metabolism, Insulin resistance, SARSCoV-2

Correspondence:

Dr. K.N. Okeke
Department of Paediatrics,
Faculty of Medicine,
Nnamdi Azikiwe University,
Awka, Anambra State,
Nigeria.
Email: kn.okeke@unizik.edu.ng

Date of Acceptance: 30th Dec., 2022

Introduction

In late 2019, a novel virus termed SARS-CoV-2 or simply “COVID-19” emerged in China. Although its origin remains largely unknown, the virus has left in its wake a devastating impact on human life and global economy.1,2 To date, the ripple effects of this virus are still clearly evident with global recovery progressing slowly due to several factors which include ongoing viral mutation and waning vaccine efficacy; side effects of existing therapies; uncontrolled media misinformation, poor political will; mass resistance to vaccinations and failure to adopt behavioural changes that mitigates viral transmission.3-8

As the world struggles to contain the global spread of the virus and its associated co-morbidities, several reports have emerged indicating a rise in pre-existing chronic disease rates, particularly among the immunecompromised and elderly.9,10 The most recent article supporting this trend was published on January 7th 2022 by the Center for Disease Control and Prevention (CDC). It demonstrated that individuals under the age of 18 with a history of contracting COVID-19 for more than a month were more likely to develop T1DM than those without the viral disease.13

Initially, anecdotal evidence attributed this alarming link between T1DM and COVID-19 to a variety of factors, including the effect of pandemic-induced stress on the chronic release of counter-regulatory hormones, late presentation of cases, and delayed diagnosis due to inadequate insurance and out-ofpocket payment. However, the recent discovery of elevated angiotensin-converting enzyme 2 receptors (the primary binding site for COVID-19) in pancreatic tissue substantiated the hypothesis of extensive damage to pancreatic beta cells exacerbating the risk of early onset T1DM, particularly in genetically susceptible individuals.17 Additionally, since children are generally exempt from receiving the COVID-19 vaccine due to the negligible risk of developing severe disease, this may provide another plausible explanation for the increasing prevalence of COVID-19-related late-onset co-morbidities, including T1DM.

Observing a similar trend in the increase of T1DM cases among children at our institution during this ongoing pandemic, we hope to contribute to the growing body of knowledge and, most importantly, raise awareness of a possible COVID-19 diabetogenic effect (both direct and indirect) among children, with particular emphasis on the demographic profile of subjects at risk.