Impact of the COVID-19 Pandemic on Children and Adolescents with New-Onset Type 1 Diabetes

Abstract

Background. The COVID-19 pandemic has an impact on the incidence of type 1 diabetes and frequency of diabetic ketoacidosis. However, the exact relationships are unclear. It is also not known whether this is a short-term phenomenon or whether the effects have long-term relevance. Furthermore, it is not known whether these changes during the pandemic are due to direct effects of SARS-CoV-2 or to changes in the patient’s environment during the pandemic. Methods. We conducted an extensive literature search on PubMed. For the estimation of relative risks of new-onset type 1 diabetes, we applied a Poisson regression model and for the comparison of incidences and we included the logarithm of person-years. Furthermore, we performed a meta-analysis using the logarithm of the relative risk for new-onset type 1 diabetes as effect size. Results. Pooling the relative risk estimates in a random-effects meta-analysis revealed that the type 1 diabetes incidence rate increased by 20% (relative risk 1.200 (95% CI 1.125, 1.281)), and that the risk of new-onset type 1 diabetes after a SARS-CoV-2 infection increased by 62% (relative risk 1.622 (95% CI 1.347, 1.953)) compared with the prepandemic period. Conclusion. There is considerable evidence that there is an increase in type 1 diabetes in children during the COVID-19 pandemic. Many studies suggesting a direct effect of SARS-CoV-2 have methodological weaknesses. As no evidence of an increase in presymptomatic cases with isolated islet autoimmunity was found, this could also suggest an accelerated transition from presymptomatic patients to clinically overt type 1 diabetes. Furthermore, there was a marked exacerbation of the preexisting increase in the prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes during the pandemic. Both the increased incidence of paediatric type 1 diabetes and the higher prevalence of diabetic ketoacidosis at diagnosis led to a massive rise in the number of children with diabetic ketoacidosis during the pandemic.

Spatiotemporal association between COVID-19 incidence and type 1 diabetes incidence among children and adolescents: a register-based ecological study in Germany

“…According to the most recent analysis based on the DPV registry data from 2020-2021, about 73-74% of children with incident type 1 diabetes in Germany are screened for diabetes-related autoantibodies, and 92-93% of the screened children are positive for at least one diabetes-related antibody (3). Of note, an effect of the COVID-19 pandemic on the autoantibody positive rate or the frequency of autoantibody negative type 1 diabetes was not observed (2,3,28,32).…”

“…estimated a non-significant odds ratio of 1.06 (95% CI: 0.59; 1.80) for the presence of multiple islet autoantibodies after a SARS-CoV-2 infection ( 24 ). However, it should be noted that some studies reported an increased risk of type 1 diabetes subsequent to a SARS-CoV-2 infection ( 27 , 28 ). One meta-analyses including three studies reported a 42% increased risk for type 1 diabetes [RR 1.42 (95% CI 1.38; 1.46)] after a SARS-CoV-2 infection ( 27 ), a second meta-analysis comprising 10 studies estimated a 62% increased risk [RR 1.622 (95% CI 1.347; 1.953)] ( 28 ).…”

“…However, it should be noted that some studies reported an increased risk of type 1 diabetes subsequent to a SARS-CoV-2 infection ( 27 , 28 ). One meta-analyses including three studies reported a 42% increased risk for type 1 diabetes [RR 1.42 (95% CI 1.38; 1.46)] after a SARS-CoV-2 infection ( 27 ), a second meta-analysis comprising 10 studies estimated a 62% increased risk [RR 1.622 (95% CI 1.347; 1.953)] ( 28 ). However, many studies suggesting a direct effect of SARS-CoV-2 infection on the type 1 diabetes risk had methodological weaknesses, in particular because asymptomatic SARS-CoV-2 infections were not adequately considered ( 28 ).…”

“…One meta-analyses including three studies reported a 42% increased risk for type 1 diabetes [RR 1.42 (95% CI 1.38; 1.46)] after a SARS-CoV-2 infection ( 27 ), a second meta-analysis comprising 10 studies estimated a 62% increased risk [RR 1.622 (95% CI 1.347; 1.953)] ( 28 ). However, many studies suggesting a direct effect of SARS-CoV-2 infection on the type 1 diabetes risk had methodological weaknesses, in particular because asymptomatic SARS-CoV-2 infections were not adequately considered ( 28 ). A most recent study reported a significant temporal association of SARS-CoV-2 infection with the development of islet autoimmunity in young children with high genetic risk for Type 1 diabetes [Hazard ratio 3.5 (95% CI: 1.6; 7.7)] ( 29 ).…”

“…The study by Rewers et 28). However, many studies suggesting a direct effect of SARS-CoV-2 infection on the type 1 diabetes risk had methodological weaknesses, in particular because asymptomatic SARS-CoV-2 infections were not adequately considered (28). A most recent study reported a significant temporal association of SARS-CoV-2 infection with the development of islet autoimmunity in young children with high genetic risk for Type 1 diabetes [Hazard ratio 3.5 (95% CI: 1.6; 7.7)] ( 29).…”