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A pair of studies released within days of one another have produced conflicting reports related to the apparent increase in type 1 diabetes diagnoses following a COVID-19 infection in younger patients.
Although one of the studies suggests a COVID-19 infection was associated with up to a 72% increase in new diagnoses of type 1 diabetes, the second, which was presented at the European Association for the Study of Diabetes 2022 annual meeting, purports that while overall rates of diagnoses may be elevated, COVID-19 may not be the cause of increased prevalence.
“Our findings call into question whether a direct association between COVID-19 and new-onset type 1 diabetes in adults and children exists”, said Helen Colhoun, MD, an investigator on the EASD 2022 study and the chair of Medical Informatics and Life Course Epidemiology at the University of Edinburgh, in a statement. “One recent report by researchers at the US CDC, analyzing two large insurance-claim databases of those under age 18, found that children with COVID-19 were 2.5 times as likely to be diagnosed with diabetes over a month after infection than those who were never infected. If replicated, this is going to create a large number of people with newly diagnosed diabetes and might also alter the risk–benefit balance for COVID-19 vaccination in young children. Importantly, we did not confirm that finding.”
Early on in the COVID-19 pandemic, each passing month brought new concerns over comorbidities or the effects of long COVID. Among endocrinologists, the most pressing concern at the height of the pandemic was the risk of severe COVID-19 associated with prediabetes, diabetes, and overweight. Now, that focus has shifted to the long-term health implications for patients, including the potential for increased risk of type 1 diabetes.
The study purporting an increased risk was conducted by Pamela B. Davis, MD, PhD, and colleagues from Case Western Reserve University School of Medicine and the MetroHealth System in Cleveland. An analysis of data from the TriNetX Analytics Platform, investigators created a pair of distinct cohorts for their analyses: one including people 18 years or younger with SARS-CoV-2 infection from March 2020-December 2021 and another including patients of the same age without SARS-CoV-2 infection but with a non-SARS-CoV-2 respiratory infection during the same period. The primary outcome of interest in propensity score-matched analysis was the risk of new diagnoses of type 1 diabetes within 1, 3, and 6 months of COVID_19 infection.
Results of this study suggested the risk of diagnosis of type 1 diabetes was greater among those infected with SARS-CoV-2 compared with those with non–COVID-19 respiratory infection at 1 month (HR, 1.96 [95%CI, 1.26-3.06]), 3 months (HR, 2.10 [95% CI, 1.48-3.00]), and 6 months (HR, 1.83 [95% CI, 1.36-2.44]) after infection.
Although the team of Ohio-based investigators noted further research is needed to further understand any potential links between SARS-CoV-2 infection and new-onset type 1 diabetes, they pushed for heightened awareness surrounding the issue.
“Families with high risk of type 1 diabetes in their children should be especially alert for symptoms of diabetes following COVID, and pediatricians should be alert for an influx of new cases of type 1 diabetes, especially since the Omicron variant of COVID spreads so rapidly among children,” said Davis, the Arline H. and Curtis F. Garvin Research Professor at Case Western University, in a statement. “We may see a substantial increase in this disease in the coming months to years. Type 1 diabetes is a lifelong challenge for those who have it, and increased incidence represents substantial numbers of children afflicted.”
In the EASD 2022 study, Colhoun and colleagues used linked EHR data from 1,849,411 individuals aged less than 35 years of age without diabetes who tested positive for SARS-CoV-2 and were followed from March 1, 2020-November 22, 2021. The primary outcome of interest for their analyses was risk of incident type 1 diabetes. For the purpose of analysis, investigators planned to compare the trends of incidence observed in the study against those from 2015-2021.
Of the 1.8 million identified for inclusion, a total of 365,080 individuals had at least 1 detected SARS-CoV-2 infection during follow-up and 1074 developed type 1 diabetes. Upon analysis, results indicated the rate ratio for type 1 diabetes associated with a first positive test was 0.86 (95% CI, 0.62-1.21) for infection less than 30 days prior to infection and 2.62 (95% CI, 1.81-3.78) for infection in the previous 30 days. Despite the observed increased in rate ratio, investigators pointed out negative and positive SARS-CoV-2 tests were more frequent in the days surrounding diabetes presentation.
“Our findings show that causes other than COVID-19 infection itself need to be considered in relation to the increased incidence of type 1 diabetes”, said study investigator Professor Paul McKeigue from Public Health Scotland and the University of Edinburgh, in the aforementioned statement from EASD 2022. “We need to consider what has happened regarding the spread of viruses such as enteroviruses during the pandemic, and whether there are any other environmental factors, such as sunlight exposure and vitamin D levels, that might have altered during lockdown that might also be relevant.”
These studies, “Relation of Incident Type 1 Diabetes to Recent COVID-19 Infection: Cohort Study Using e-Health Record Linkage in Scotland,” and “Association of SARS-CoV-2 Infection With New-Onset Type 1 Diabetes Among Pediatric Patients From 2020 to 2021,” were published in Diabetes Care and JAMA Network Open, respectively.