COVID-19 not linked to development of type 1 diabetes in children: NEJM

In their study, published in The New England Journal of Medicine, the researchers tested more than 4,500 adolescents every few months for SARS-CoV-2 infection, type 1 diabetes, and vaccination antibodies from 2020 through 2021. However, they found no difference among the 45 kids with a diagnosis of type 1 diabetes during this time when it came to COVID-19 infection history.

"These findings must be tempered somewhat because they reflect a narrow age range among kids with an increased genetic risk of type 1 diabetes," Jeffrey P. Krischer, University of South Florida, Tampa, FL, and colleagues wrote in their study.

Previous studies have widely reported an increased incidence of type 1 diabetes in kids during the coronavirus disease 2019 (Covid-19) pandemic. Dr Krischer and colleagues conducted a study comprising 4586 children aged 9 to 15 years from Germany, Finland, Sweden, and the US.

Follow-up of the children was done from January 2020 (pre-pandemic) through December 2021 (pandemic). They were tested every 3 months for T1D if they had islet autoantibodies (440 participants) and every 6 months if they did not (4146 participants).

Testing of the children was done for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) nucleocapsid (infection) and spike (vaccination) antibodies at each follow-up visit.

The authors reported the following findings:

• Five of the children were diagnosed with type 1 diabetes before testing positive for SARS-CoV-2 nucleocapsid antibodies. One child was diagnosed with diabetes after a COVID infection.
• For the other 39 kids diagnosed with type 1 diabetes during the study, they never had a positive test for nucleocapsid antibodies. Of these, 30 were never vaccinated, two were vaccinated before the diagnosis of type 1 diabetes, four were vaccinated after the diagnosis, and three were not tested.
• Among the 4,586 children ages 9 to 15 included in the study, 15.4% tested positive for SARS-CoV-2 nucleocapsid antibodies. This included 15% of 4,146 children without islet autoantibodies and 18.6% of 440 children with islet autoantibodies.
• For kids without islet autoantibodies, only 40 kids experienced seroconversion to persistent and confirmed positivity for islet autoantibodies. Of these kids, only five had nucleocapsid antibodies -- which appeared after seroconversion. The other 35 kids never tested positive for nucleocapsid antibodies.
• None of the other 623 children without islet autoantibodies who had SARS-CoV-2 infection experienced seroconversion. Seroconversion was seen only in the 1% of children without islet autoantibodies who didn't have a SARS-CoV-2 infection.
• Participants were located in Finland, the U.S., Germany, and Sweden, with Sweden having the highest rates of COVID-19 among children (21.5%).
• COVID-19 rates were double for those with a BMI between 36 and 40 (30%).

"Despite the plausibility of a biologic connection, systematic testing for the virus and T1D in a prospective, multinational cohort of children before and during the pandemic did not reveal that Covid-19 precipitated type 1 diabetes, in contrast to studies in which Covid-19 testing was not performed," the authors concluded.

Reference:

Krischer JP, Lernmark Å, Hagopian WA, Rewers MJ, McIndoe R, Toppari J, Ziegler AG, Akolkar B; TEDDY Study Group. SARS-CoV-2 - No Increased Islet Autoimmunity or Type 1 Diabetes in Teens. N Engl J Med. 2023 Aug 3;389(5):474-475. doi: 10.1056/NEJMc2216477. PMID: 37530831.