COVID-19 infection in children may increase T1D risk: JAMA

Since 2020, a COVID-19 diagnosis in children has been linked to an increase in the occurrence of type 1 diabetes in Bavaria, says an article published in the Journal of American Medical Association.

During the COVID-19 pandemic, the prevalence of type 1 diabetes in children rose, although studies did not differentiate between children with and without infection. Andreas Weiss and colleagues examined an extensive population-based, individual-patient data set which included COVID-19 diagnoses to see if there was a temporal connection between COVID-19 and type 1 diabetes in children.

The Bavarian Association of Statutory Health Insurance Physicians (BASHIP) handles claims for all statutorily insured patients in Bavaria, Germany (around 85% of the entire Bavarian population). This research used anonymized data from all infants born between 2010 and 2018 and monitored in the BASHIP database through December 2021. Medically attended COVID-19 and type 1 diabetes diagnoses were reported in quarterly (3-month) calendar intervals with no information on the precise date of diagnosis. Clinicians input illness codes indicating if COVID-19 was viral confirmed (polymerase chain reaction positive) for COVID-19.

The prevalence of type 1 diabetes was examined between 2018-2019 and 2020-2021. On a quarterly basis in 2020-2021, time-dependent Cox models adjusted for children's gender and age were used to predict the risk of type 1 diabetes linked with a COVID-19 diagnosis. A sensitivity analysis was undertaken to rule out COVID-19 diagnoses that did not have viral confirmation. 

The key findings of this study were:

1. Through December 2019, 1242 of the 1 181 878 children having medical claims data were diagnosed with type 1 diabetes.

2. Between January 2020 and December 2021, 195 795 of the remaining 1 180 636 children without widespread type 1 diabetes at the start of 2020 were diagnosed with COVID-19.

3. COVID-19 first-time diagnoses varied from 0.18% in January to March 2020 to 4.79% in October to December 2021.

4. Boys had a greater frequency than girls, and children less than the median age of 6.5 years had a higher frequency (18.6%) than older children (14.6%).

5. Between January 2020 and December 2021, the incidence rate of type 1 diabetes was 29.9 per 100,000 person-years, compared to 19.5 between January 2018 and December 2019.

6. In the absence of a prior or concurrent COVID-19 diagnosis, the incidence rate of type 1 diabetes during the pandemic was 28.5 per 100,000 person-years.

7. In the same quarter as the COVID-19 diagnosis, the incidence rate of type 1 diabetes was 55.2 per 100 000 person-years.

8. In the next two quarters, the incidence rate was 38.8 and 50.7, respectively.

Reference:

Weiss, A., Donnachie, E., Beyerlein, A., Ziegler, A.-G., & Bonifacio, E. (2023). Type 1 Diabetes Incidence and Risk in Children With a Diagnosis of COVID-19. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2023.8674