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Impact of the COVID-19 Pandemic on Children and Adolescents with New-Onset Type 1 Diabetes
Clemens Kamrath1, Alexander J Eckert2,3, Reinhard W Holl3,4
1Centre of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany.
Insights
The COVID-19 pandemic is linked to a 20% rise in type 1 diabetes incidence. SARS-CoV-2 infection also increased new-onset type 1 diabetes risk by 62%, with more children diagnosed with diabetic ketoacidosis.
Area of Science:
- Endocrinology
- Epidemiology
- Virology
Background:
- The COVID-19 pandemic's impact on type 1 diabetes (T1D) incidence and diabetic ketoacidosis (DKA) frequency is unclear.
- Uncertainty exists regarding the short-term vs. long-term relevance of these pandemic-related changes.
- The role of direct SARS-CoV-2 effects versus environmental changes in these observed alterations is unknown.
Purpose of the Study:
- To investigate the relationship between the COVID-19 pandemic and the incidence of type 1 diabetes.
- To assess the pandemic's effect on the frequency and severity of diabetic ketoacidosis at diagnosis.
- To evaluate the potential link between SARS-CoV-2 infection and new-onset type 1 diabetes.
Main Methods:
- Extensive literature search conducted on PubMed.
- Poisson regression model applied for relative risk estimation of new-onset T1D.
- Random-effects meta-analysis performed to pool relative risk estimates.
Main Results:
- A 20% increase in type 1 diabetes incidence rate was observed during the pandemic compared to pre-pandemic levels.
- The risk of new-onset type 1 diabetes following SARS-CoV-2 infection was 62% higher.
- A significant exacerbation of diabetic ketoacidosis at diagnosis for T1D was noted during the pandemic.
Conclusions:
- Evidence suggests an increase in pediatric type 1 diabetes during the COVID-19 pandemic.
- Methodological limitations exist in studies suggesting direct SARS-CoV-2 effects; accelerated T1D transition is a possibility.
- The rise in T1D incidence and DKA prevalence led to a substantial increase in pediatric DKA cases during the pandemic.
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.
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