1 - Hospital de Dona Estefânia - CHULC, Unit of Pediatric Endocrinology and Diabetes, Lisboa, Portugal, 2-Universidade Nova de Lisboa, Lisboa, Portugal
- Publicação sob a forma de resumo no congresso internacional International Society for Pediatric and Adolescent Diabetes
Introduction: Since September 2021, there was an increase in SARSCoV- 2 infection among schoolers. Empirically, T1D patients seemed to have an increase in hypoglycemia episodes just before SARSCoV- 2 infection was detected. Several studies showed that viruses evolve a series of mechanisms to weaken and evade the host immune defense. SARS-CoV-2 uses N6-methyladenosine (m6A) incorporation into its RNA to mimic host RNA and evade recognition. Moreover, it was found that methyltransferase 3, an m6A writer, also stimulates glucose transporter 1 and hexokinase 2 in host cells, driving the glycolytic metabolism, and leading to glycemia decrease. Objectives: To evaluate if glycemia decrease in the week before SARSCoV- 2 detection, could be a possible infection prodrome in T1D.
Methods: Pediatric single-center study based on clinical and isCGM data from subjects with T1D and positive PCR for SARS-CoV-2. Collected variables: demographics, age at onset, insulin treatment, glycemic control, SARS-CoV-2 vaccination. Data during the 2 weeks before, and the 2 weeks after a positive swab were analyzed.
Results: From 348 T1D patients, 162 (46.6%) had recorded SARSCoV-2 infection. After excluding those without isCGM data, 158 subjects were enrolled: 56% males, with a median age of 14(2–19)y, and a median T1D duration of 6(0–18)y. 77% were on CSII, and the median HbA1c was 7.4(6.8–10.2)%. A 2 weeks before SARS-CoV-2 detection, median average glucose was 178 (132-227) mg/dl, median TIR (70–180 mg/dl) was 54(21– 93)%, and median TBR was 5 (0–7)%. During the week immediately before SARS-CoV-2 detection, there was a decrease in median average glucose [Δ _31(_63 to _26)mg/dl; p < 0.01], and an increase in median TBR [Δ 3.5(2 to 5)%; p < 0.01].
Conclusions: Initial SARS-CoV-2 infection was linked to an increase in insulin sensitivity and hypoglycemia episodes in T1D. More studies on the virus epitranscriptomic regulation need to be done to understand the mechanisms underlying this phenomenon.