Type 1 diabetes incidence increased during the COVID ‐19 pandemic years 2020–2021 in Czechia: Results from a large population‐based pediatric register

Abstract

Background To explore type 1 diabetes incidence patterns during the pandemic years 2020 and 2021 in Czechia, to compare them to the trends from the previous decade, and to test its association with indicators of containment measures and of pandemic severity (school closing and the all‐cause excess mortality). Methods The Czech Childhood Diabetes Register is a population‐based incidence register recording patients age 0–14.99 years at diabetes onset. Type 1 diabetes incidence in the pandemic period (April 2020–end of observation Dec 2021) was compared by Poisson regression models to the incidence patterns over the past decade 2010–2019. Results During the pandemic years 2020–2021, 956 children 0–14.99 years old manifested with type 1 diabetes in Czechia. The observed incidence (27.2/100,000/year) was significantly higher than what was expected from the trends over 2010–2019 (incidence rate ratio, IRR = 1.16, 95%CI 1.06–1.28, p = 0.0022). The incidence had a trough during the first lockdown (March–May 2020), then it rose above expected values with no usual summer decrease. The assessed pandemic indicators (school closing and all‐cause excess mortality) were not associated with the incidence levels. Conclusions The COVID‐19 pandemic was associated with a notable upward inflection of the type 1 diabetes incidence curve; the early months of the first lockdown were however hallmarked by a significant dip in new diabetes diagnoses. Long‐term observation will show whether the increased incidence originated only from accelerating an advanced preclinical Stage 2 to overt diabetes, or whether the pandemic triggered new cases of islet autoimmunity.

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

“…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.…”

“…Twenty-four studies (57.1%) reported DKA incidence at diagnosis . Incident cases of type 1 and type 2 diabetes were reported in 36 studies (85.7%) and 9 studies (21.4%), respectively. Two studies (4.8%) did not distinguish between diabetes types .…”

“…Two studies (4.8%) did not distinguish between diabetes types . Thirty-two studies (76.2%) included children only, while the rest (10 [23.8%]) included both children and adults . Twenty-one studies (50.0%) were from Europe, 12 (28.6%) from North America, 7 (16.7%) from Asia, and 1 (2.4%) from Australia; 1 study (2.4%) included data from multiple countries across different continents.…”

“…Twenty-four studies (57.1%) reported DKA incidence at diagnosis. 3, 5, 6, 8, 9, 12, 14, 18, 19, 22, 25, 27-31, 34, 35, 37, 38, 40, 42, 48, 49 Incident cases of type 1 and type 2 diabetes were reported in 36 studies (85.7%) 12,23,24,[27][28][29][30][31][32][33][35][36][37][38][39][40][41][42][44][45][46][47][48][49][50][51][52][53][54][55][56][58][59][60][61]63 and 9 studies (21.4%), 3,33,34,39,43,45,46,55,62 respectively. Two studies (4.8%) did not distinguish between diabetes types.…”

Risk for Newly Diagnosed Type 2 Diabetes Mellitus after COVID-19 among Korean Adults: A Nationwide Matched Cohort Study

“…Moreover, recent evidence suggests that COVID-19 may affect various organs in the body even after 30 days, the acute phase of infection, increasing the risk of non-communicable diseases in the extrapulmonary organs [5]. Several studies have shown that autoimmunity against pancreatic beta cells increased after COV-ID-19 which may also increase the risk of type 1 diabetes [6,7]. Additionally, small-scale studies have suggested that COV-ID-19 might increase the incidence of type 2 diabetes mellitus (T2DM) [8,9], and recent large cohort studies from national healthcare databases have also shown a risk of developing diabetes [10][11][12].…”