SARS-CoV-2 and type 1 diabetes in children in Finland: an observational study

Knip, Mikael; Parviainen, Anna; Turtinen, Maaret; But, Anna; Härkönen, Taina; Hepojoki, Jussi; Sironen, Tarja; Iheozor-Ejiofor, Rommel; Uğurlu, Hasan; Saksela, Kalle; Lempainen, Johanna; Ilonen, Jorma; Vapalahti, Olli

doi:10.1016/s2213-8587(23)00041-4

Cited by 28 publications

(33 citation statements)

References 39 publications

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“…After the abstract review, we retrieved 81 full-text articles to determine eligibility. Forty-two records met the full inclusion criteria . The manual search of the included studies’ reference lists did not yield additional studies.…”

Section: Resultsmentioning

confidence: 99%

“…In our post hoc additional analysis, among studies that reported more than 12 months after pandemic onset, there was an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the prepandemic period (IRR, 1.27; 95% CI, 1.18-1.37) (Figure 2B) . The results of the remaining 20 studies, which reported the number of incident type 1 diabetes cases but were not included in the meta-analysis because they did not report the size of the study population, are summarized in Table 3 . Of these, 15 (75.0%) reported an increase in the number of incident cases of type 1 diabetes during the first 12 months of the pandemic compared with during the 12 months before the pandemic …”

Section: Resultsmentioning

confidence: 99%

“…The results of the remaining 20 studies, which reported the number of incident type 1 diabetes cases but were not included in the meta-analysis because they did not report the size of the study population, are summarized in Table 3 . Of these, 15 (75.0%) reported an increase in the number of incident cases of type 1 diabetes during the first 12 months of the pandemic compared with during the 12 months before the pandemic …”

Section: Resultsmentioning

confidence: 99%

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Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

D’Souza,

Empringham,

Pechlivanoglou

et al. 2023

JAMA Netw Open

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ImportanceThere are reports of increasing incidence of pediatric diabetes since the onset of the COVID-19 pandemic. Given the limitations of individual studies that examine this association, it is important to synthesize estimates of changes in incidence rates.ObjectiveTo compare the incidence rates of pediatric diabetes during and before the COVID-19 pandemic.Data SourcesIn this systematic review and meta-analysis, electronic databases, including Medline, Embase, the Cochrane database, Scopus, and Web of Science, and the gray literature were searched between January 1, 2020, and March 28, 2023, using subject headings and text word terms related to COVID-19, diabetes, and diabetic ketoacidosis (DKA).Study SelectionStudies were independently assessed by 2 reviewers and included if they reported differences in incident diabetes cases during vs before the pandemic in youths younger than 19 years, had a minimum observation period of 12 months during and 12 months before the pandemic, and were published in English.Data Extraction and SynthesisFrom records that underwent full-text review, 2 reviewers independently abstracted data and assessed the risk of bias. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Eligible studies were included in the meta-analysis and analyzed with a common and random-effects analysis. Studies not included in the meta-analysis were summarized descriptively.Main Outcomes and MeasuresThe primary outcome was change in the incidence rate of pediatric diabetes during vs before the COVID-19 pandemic. The secondary outcome was change in the incidence rate of DKA among youths with new-onset diabetes during the pandemic.ResultsForty-two studies including 102 984 incident diabetes cases were included in the systematic review. The meta-analysis of type 1 diabetes incidence rates included 17 studies of 38 149 youths and showed a higher incidence rate during the first year of the pandemic compared with the prepandemic period (incidence rate ratio [IRR], 1.14; 95% CI, 1.08-1.21). There was an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the prepandemic period (IRR, 1.27; 95% CI, 1.18-1.37). Ten studies (23.8%) reported incident type 2 diabetes cases in both periods. These studies did not report incidence rates, so results were not pooled. Fifteen studies (35.7%) reported DKA incidence and found a higher rate during the pandemic compared with before the pandemic (IRR, 1.26; 95% CI, 1.17-1.36).Conclusions and RelevanceThis study found that incidence rates of type 1 diabetes and DKA at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

D’Souza,

Empringham,

Pechlivanoglou

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

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“…Recent clinical data on new-onset T1DM are conflicting, mostly evaluated in children, adolescents, and young adults [29][30][31][32]. From the results of an analysis of more than 80 million deidentified patient electronic records globally in the first 15 months of the pandemic from the Tri-NetX COVID-19 research network, the authors concluded that the incidence of T1DM among patients with COVID-19 below 30 years of age is not greater when compared with the age-, sex-, and BMI-matched population without COVID-19 [33].…”

Section: Sars-cov-2 Infection -Associations With Incident Diabetes Me...mentioning

confidence: 99%

COVID-19, Pregnancy, and Diabetes Mellitus

Kleinwechter,

Weber,

Liedtke

et al. 2023

Z Geburtshilfe Neonatol

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During the severe acute respiratory distress virus coronavirus type 2 (SARS-CoV-2) pandemic, many women were infected during their pregnancies. The SARS-CoV-2-induced coronavirus disease 19 (COVID-19) has an impact on maternal health and pregnancy outcomes; peripartum and perinatal morbidity and mortality are increased. Pregnancy is considered a risk factor for severe COVID-19 course. Additional risk factors during pregnancy are diabetes mellitus, gestational diabetes mellitus (GDM), and obesity. Systemic inflammation can lead to severe metabolic dysregulation with ketoacidosis. The endocrine pancreas is a target organ for SARS-CoV-2 and the fetal risk depends on inflammation of the placenta. Up to now there is no evidence that SARS-CoV-2 infection during pregnancy leads to permanent diabetes in mothers or their offspring via triggering autoimmunity or beta cell destruction. The frequently observed increased prevalence of GDM compared to the years before the pandemic is most likely due to changed lifestyle during lockdown. Furthermore, severe COVID-19 may be associated with the development of GDM due to worsening of glucose tolerance. Vaccination with a mRNA vaccine is safe and highly effective to prevent infection and to reduce hospitalization. Registries support offering evidence-based recommendations on vaccination for pregnant women. Even with the current omicron virus variant, there are increased risks for symptomatic and unvaccinated pregnant women.

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“…Recent data from Finland showed an increased incidence rate ratio of 1.16 (95% CI, 1.06-1.25) of childhood type 1 diabetes during the first 18 months of the pandemic compared with a prepandemic period. Importantly, of 583 children with newly diagnosed type 1 diabetes who were tested for SARS-CoV-2 antibodies, only 5 (0.9%) were positive . Furthermore, a study using data from 51 970 children and adolescents of 2 large registries in Colorado, US, and Bavaria, Germany, found no significant association between antibodies against SARS-CoV-2 and the development of multiple type 1 diabetes-associated autoantibodies (odds ratio, 1.06 [95% CI, 0.59-1.08]) or singular high-affinity islet autoantibodies (odds ratio, 1.34 [0.70-2.44]) …”

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confidence: 99%