Frequency of Autoantibody-Negative Type 1 Diabetes in Children, Adolescents, and Young Adults During the First Wave of the COVID-19 Pandemic in Germany

Abstract

The aim of this study was to investigate the frequency of newly diagnosed type 1 diabetes without evidence of autoimmunity and the respective frequencies of ketoacidosis in children, adolescents, and young adults during the coronavirus disease 2019 (COVID-19) pandemic in Germany compared with the previous decade. RESEARCH DESIGN AND METHODSBased on data from the German Diabetes Prospective Follow-up Registry (DPV), we compared data from 715 children, adolescents, and young adults, newly diagnosed with type 1 diabetes during the COVID-19 pandemic in Germany between 1 March and 30 June 2020, with data from 5,428 children, adolescents, and young adults of the same periods from 2011 to 2019. Adjusted differences and relative risks (RRs) of negative b-cell autoantibody test results and diabetic ketoacidosis were estimated using multivariable log-binomial regression analysis. An upper noninferiority test (margin 1%) was applied to evaluate whether the autoantibody-negativity rate in 2020 was not higher than that in 2011 to 2019. RESULTSThe estimated frequencies of autoantibody negativity in 2020 and 2011-2019 were 6.6% (95% CI 5.1-8.4) and 7.2% (95% CI 6.5-8.0), respectively, with an absolute difference of À0.68% (90% CI À2.07 to 0.71; P upper noninferiority = 0.023). The increase of the estimated frequency of diabetic ketoacidosis during the COVID-19 pandemic was similar between autoantibody-negative and -positive type 1 diabetes (adjusted RRs 1.28 [95% CI 0.80-2.05] and 1.57 [1.41-1.75], respectively). CONCLUSIONSThis study found no evidence that the COVID-19 pandemic leads to a significantly increased number of new cases with autoantibody-negative type 1 diabetes in children, adolescents, and young adults. In addition, autoantibody-negative type 1 diabetes showed no particular susceptibility to ketoacidosis, neither before nor during the pandemic.

Increase in newly diagnosed type 1 diabetes in youth during the COVID ‐19 pandemic in the United States : A multi‐center analysis

“… 13 In another analysis of newly diagnosed T1D across Germany during the first wave of the pandemic (March 1 to June 30, 2020), there was no increase in T1D diagnosis in this time frame compared to the prior 8 years. 16 , 17 While these previous studies are limited by small sample sizes and include data from only the first wave of the pandemic, our analysis offers a first look at the longitudinal data spanning multiple institutions across the United States, multiple waves of the pandemic, and a diverse patient population.…”

“…However, published reports have shown conflicting findings, with some reports suggesting an increase in newly diagnosed T1D in children and adolescents, 13 , 14 , 15 and others showing no change in expected or actual numbers of newly diagnosed T1D. 16 , 17 Our objective for this study was to describe trends in newly diagnosed T1D, as well as the severity of presentation at diagnosis during COVID‐19 compared to the prior year using data from seven large U.S. clinical centers.…”

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

“…By contrast, insulin deficiency due to direct destruction of beta cells by SARS-CoV-2 does not seem to play an important role in children with newly diagnosed type 1 diabetes. 23 …”

Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies

“…Conversely, a German study showed that COVID-19 infection did not increase type 1 diabetes cases when there was no evidence of autoimmunity. Importantly, this study only covered the first wave of the pandemic in Germany (approximately four months period) ( 54 ). Thus, possible links cannot be entirely ruled out, but larger studies are needed to confirm them.…”