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COVID-19 in children with diabetes: ISPAD recommendations

Children at home during the COVID-19 crisis

An international body has released recommendations regarding COVID-19 in children with diabetes.

The guidance, issued by the International Society for Pediatric and Adolescent Diabetes (ISPAD) is directed at healthcare professionals who may have children, adolescents and young adults with diabetes under their care.

In many countries, people with diabetes have been categorised as being at a higher risk of COVID-19. However, anecdotal reports reassuringly indicate that COVID-19 in children with diabetes has not shown a different pattern to their non-diabetic peers, according to the ISPAD.

The guidance includes similar advice to that given regarding adults that we should all be following, including washing hands and social distancing.

ISPAD say that if a child or young person with diabetes becomes unwell, then they should increase the frequency of blood glucose testing and aim for a blood glucose level between of 4 and 10 mmol/L (70-180 mg/dL) and blood ketones below 0.6 mmol/L.

Additionally, the organisation says that insulin should never be stopped, and it should be kept in mind that when suffering with a fever, it is common for more insulin to be needed to keep blood glucose under control. Children and young people should be monitored, and they should maintain hydration with an adequate salt and water balance.

The organisation stated: “Despite many uncertainties, the COVID-19 pandemic recommendations in most countries include people with diabetes within the at-risk population.

“However, there are anecdotal reports that children with diabetes have not shown a different disease pattern compared to their peers. In addition, children in general are less affected than adults.”

Urgent specialist advice to help healthcare professionals decide whether emergency care must be sought has also been published. This includes:

  • If a fever or vomiting persists and/or, weight loss continues – this could suggest worsening dehydration
  • If a fruity breath odour persists or worsens, or if blood ketones remain elevated above 1.5 mmol/L
  • If a child or adolescent becomes exhausted, confused, hyperventilate or has severe abdominal pain

ISPAD added: “While we wait for a specific treatment or vaccine against coronavirus, we should take good care of our patients. It is reassuring to remember that reports of COVID-19 infection suggest that it is less severe in children and adolescents.

“ISPAD wishes that the entire diabetes community can join together during this difficult time, and that our patients can go back to their regular lives as soon and as safe as possible.”

To access the guidance in full, click here.

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