Relation of Incident Type 1 Diabetes to Recent COVID-19 Infection: Cohort Study Using e-Health Record Linkage in Scotland

Abstract

OBJECTIVE Studies using claims databases reported that SARS-CoV-2 infection >30 days earlier was associated with an increase in the incidence of type 1 diabetes. Using exact dates of diabetes diagnosis from the national register in Scotland linked to virology laboratory data, we sought to replicate this finding. RESEARCH DESIGN AND METHODS A cohort of 1,849,411 individuals aged <35 years without diabetes, including all those in Scotland who subsequently tested positive for SARS-CoV-2, was followed from 1 March 2020 to 22 November 2021. Incident type 1 diabetes was ascertained from the national registry. Using Cox regression, we tested the association of time-updated infection with incident diabetes. Trends in incidence of type 1 diabetes in the population from 2015 through 2021 were also estimated in a generalized additive model. RESULTS There were 365,080 individuals who had at least one detected SARS-CoV-2 infection during follow-up and 1074 who developed type 1 diabetes. The rate ratio for incident type 1 diabetes associated with first positive test for SARS-CoV-2 (reference category: no previous infection) was 0.86 (95% CI 0.62, 1.21) for infection >30 days earlier and 2.62 (95% CI 1.81, 3.78) for infection in the previous 30 days. However, negative and positive SARS-CoV-2 tests were more frequent in the days surrounding diabetes presentation. In those aged 0–14 years, incidence of type 1 diabetes during 2020–2021 was 20% higher than the 7-year average. CONCLUSIONS Type 1 diabetes incidence in children increased during the pandemic. However, the cohort analysis suggests that SARS-CoV-2 infection itself was not the cause of this increase.

The bidirectional association between diabetes and long-COVID-19 – A systematic review

“…Risk estimates were lower when the comparison population was AURI (Hazard Ratio: 2.66 (1.98-3.56) vs. non-COVID-19 (2.16 (1.64-2.86). In Scotland, [30] no increased risk was observed in people with vs. without COVID-19 aged <35 years, and in another US study, non-hospitalized and hospitalized children aged <20 years with COVID-19 had a 27% and 114% increased risk of diabetes as compared to people without COVID-19, respectively. [34] Finally, in another US study, new-onset diabetes was increased in children aged 10-18 years at 3 months (HR: 2.40 (1.62-3.56)) and 6 months (HR: 2.18 (1.57-3.03), but not in children aged 0-9 years.…”

“…Overall, 12/14 (86%) studies reported that COVID-19 was associated with an 11% to 276% increased risk for incident diabetes, with risk estimates varying depending on comparison population (i.e., non-COVID-19 vs. acute upper respiratory infection (AURI)), hospitalization status, and age (i.e., adults vs. children). Of the two studies that report no association, one examined any new diabetes diagnosis in 1.85 million people aged <35 years (i.e., Type 1 diabetes) in Scotland (Hazard Ratio: 0.86, 95%CI: 0.62-1.21) [30] and the other examined new-onset diabetes 12-months after hospitalization with acute pancreatitis (and with vs. without COVID-19 infection) (OR: 0.61 (0.13-2.96). [31] …”

Diabetes Mellitus after COVID-19 infection in a healthcare worker

“…Besides, a study of two large databases of more than 2.5 million children indicated that those with COVID-19 presented a higher risk of new diabetes than those without COVID-19 [18]. An analysis, which is not yet peer-reviewed, of 1.8 million people aged younger than 35 years also suggested an increased risk of diabetes within, but not beyond, the first 30 days after SARS-CoV-2 infection [34].…”

Impact of SARS-CoV-2 infection on disease trajectory in youth with T1D: An EHR-based cohort study from the RECOVER program

“…Hence, we conducted a sensitivity analysis to confirm the robustness of our findings. Specifically, the irregular visiting times were firstly modeled, and the generalized estimating equation (GEE) is then fitted with inverse-intensity-of-visit-process weighting (22; 23). The effect sizes in propensity score strata were then aggregated using fixed-effect meta-analysis.…”