Coronavirus disease (COVID-19) information for children and adolescents living with endocrine conditions, including type 1 diabetes mellitus

The World Health Organization (WHO) has declared the outbreak of the novel coronavirus disease (COVID-19) a pandemic. Older people and people with pre-existing medical conditions (such as poorly-controlled diabetes) appear to be more vulnerable to becoming severely ill with this viral infection.

Having in mind that children and adolescents can also be infected by the new coronavirus (2019-nCoV), many questions regarding COVID-19 have been raised by the families and caregivers of children and adolescents with endocrine conditions, including type 1 diabetes.

Therefore, the European Society for Paediatric Endocrinology (ESPE) is providing the following information and recommendations, based on the currently available data:

What is the risk: There are no reliable data suggesting that children with well-managed endocrine conditions (including type 1 diabetes mellitus) are at increased risk of getting infected or becoming severely ill with coronavirus. Also, it is encouraging to know that the coronavirus illness generally has a milder course in children (link for the published findings provided below). However, poorly controlled diabetes mellitus can weaken the immunity and thereby increase the risk of getting infected by the virus. There are some indications that otherwise healthy, but severely obese, children are at increased risk of a more complicated lung infection due to a COVID-19 infection. New data is becoming available each day, and in the meantime parents and caregivers of children with endocrine conditions are advised to be vigilant to prevent COVID-19 infection by strict application of the preventive measures.

How to minimise the risk: Wash your hands frequently, maintain social distancing and implement protective measures at all times. This of course applies both to parents and caregivers, as well as children. A link to the WHO webpage with detailed guidelines on preventive measures is provided below.

School and isolation: Children with diabetes and other endocrine conditions should follow local regulations regarding school and self-isolation. If home-based remote learning is an option, this mode of school attendance currently represents a safer approach for all children, including those with endocrine conditions.

In case of symptoms: Please call your physician (or the emergency telephone number), explain the symptoms and follow the official medical advice. For most mild cases, home rest in self-isolation is sufficient, but this decision should not be made solely by parents or caregivers. To repeat – please consult your physician and follow official medical advice.

Type 1 diabetes management during coronavirus illness: Children with well-managed diabetes are expected to have the same course of illness as their peers. We recommend following the general advice for “sick day” management by the International Society for Pediatric and Adolescent Diabetes (ISPAD) and contacting your paediatric endocrinologist. Do not stop the insulin treatment, increase the dose as needed and frequently measure blood glucose and ketones. A link to the ISPAD webpage with detailed guidelines on “sick day” management of type 1 diabetes during coronavirus illness is provided below.

Adrenal insufficiency management during coronavirus illness: If the child becomes symptomatic, we recommend increasing the hydrocortisone dose, according to the general “sick day rules” in children with adrenal insufficiency due to congenital adrenal hyperplasia (CAH), panhypopituitarism (pituitary failure), Addison’s disease,  after long-term use of steroid medication, or any other cause. Follow your endocrinologist’s standard advice on “sick day” management, and if unsure give the extra dose of hydrocortisone and immediately contact your endocrinologist or emergency care physician.

Other endocrine conditions during coronavirus illness: In the case of coronavirus illness in children with various other endocrine conditions, we expect a same course of illness as their peers and recommend following the usual management advice for sick children.

Insulin, hydrocortisone and other medications supply during the global outbreak: Although you should always have enough supplies of insulin/hydrocortisone/other medications for at least a week in advance, we do not recommend stocking up larger quantities of insulin or other medications, since this could endanger the supply chain and lead to regional or global shortages. At the present time, there have been no reports on the shortage of insulin or other medications. Please maintain the usual amount of back-up insulin/medications and follow the local regulations and announcements.

Please bear in mind that our current knowledge on COVID-19 is limited by the lack of data, and further information and guidance will be provided as new data becomes available. Please stay connected and follow future updates from the WHO, ESPE and, for children with type 1 diabetes, from ISPAD.

Please wash your hands frequently, stay at home as much as possible and at least 1.5 meters away from non-family members.

ESPE Secretary General

ESPE Communication Committee

Useful links:

1. ESPE Website: http://www.eurospe.org/

2. ESPE Facebook page: https://www.facebook.com/EuroSPE/

3. WHO COVID-19 webpage: http://www.who.int/emergencies/diseases/novel-coronavirus-2019

4. ISPAD COVID-19 webpage: https://www.ispad.org/page/CoronavirusinfectionCOVID-19

5. ADA COVID-19: http://www.diabetes.org/diabetes/treatment-care/planning-sick-days/coronavirus

6. SARS-CoV-2 Infection in Children: http://www.nejm.org/doi/full/10.1056/NEJMc2005073

Published: 3 April 2020