Abstract

Objective

This study aimed to systematically evaluate the impact of concurrent respiratory viral infections on the acute severity of diabetic ketoacidosis (DKA), long-term glycemic control, and residual pancreatic β-cell function in children and adolescents with newly diagnosed type 1 diabetes mellitus (T1DM), so as to provide an evidence-based basis for clinical management.

Methods

A total of 113 children and adolescents with newly diagnosed T1DM complicated by DKA were enrolled and divided into an exposed group (respiratory virus-positive, n=28) and a control group (no respiratory infection symptoms, virus-negative, n=85) based on virus detection results within 48 hours of initial diagnosis. Demographic, hospitalization, pancreatic β-cell function, DKA-related indicators, and T1DM autoantibodies were collected. All participants were followed up at 3 and 6 months to record HbA1c, insulin dosage, and DKA recurrence.

Results

Results showed that the exposed group had significantly longer hospital stays, higher ICU admission rates, lower fasting C-peptide levels, higher incidences of severe DKA and cerebral edema, more severe acid-base imbalance and hyponatremia, greater 24-hour fluid volume, and longer DKA correction time (all P<0.05). Regardless of treatment with an insulin pump (n=75) or insulin pen (n=38), the exposed group had significantly higher HbA1c and lower serum C-peptide levels at follow-ups (P<0.05). Notably, the insulin pen subgroup in the exposed group had higher insulin dosage and DKA recurrence rate.

Conclusion

Concurrent respiratory viral infections significantly increase DKA acute severity, exacerbate pancreatic β-cell dysfunction, and impair long-term glycemic control in newly diagnosed pediatric T1DM, highlighting the need for prioritized virus screening, prevention, and optimized individualized treatment.