E. coli O157:H7, the culprit in foodborne illness outbreaks linked to everything from ground beef to cookie dough, produces a Shiga-like toxin that damages the filtering part of the kidney and leads to a life-threatening complication, hemolytic uremic syndrome (HUS), in 2-7 percent of all infections.

The pathogen is particularly hard on children; 90 percent of all HUS cases in children are the result of diarrhea-associated E. coli O157:H7 infections.

But while the toxin generally is known to affect renal function and the central nervous system, it also can involve the pancreas, damaging the insulin-producing cells and causing an insulin deficiency–diabetes.

Children who suffer from severe cases of HUS, and need dialysis, for example, are the most likely to develop diabetes and to develop it quickly, within 14 days of their hospitalization.

One review of the studies in the scientific literature, published in the American Diabetes Association’s Diabetes Care journal, found that of 44 children whose HUS/diabetes cases were followed, 10 died and 34 survived. About one-third of these young HUS survivors were left with persistent diabetes, an estimate that may just be the tip of the iceberg.

The study said “the rate of permanent diabetes may in fact be higher than reported,” given that relapse can occur up to five years after the acute illness, and nearly half the recovering children studied were not followed after one year.

Another paper examined the case of a teenager who had HUS as a 3-year-old and developed diabetes 10 years later. HUS “may evolve to  … non-autoimmune diabetes mellitus even after a long free interval,” the study concluded, adding that long-term follow up patients with HUS is recommended.