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Can COVID-19 cause type 1 diabetes in children? Time will tell

 


Editor’s Note: See Medscape’s latest COVID-19 news and guidance. coronavirus resource center.

STOCKHOLM, SWEDEN — Whether SARS-CoV-2 infection increases the risk of children and adolescents is still inconclusive. type 1 diabetesData from two new studies published last week and a just-published dossier add to the arsenal of knowledge on the subject, but no definitive conclusions can yet be drawn.

The latest results of Norwegian and Scottish studies, both examining the incidence of type 1 diabetes in adolescents with a history of SARS-CoV-2 infection, were presented at this year’s European Diabetes Society (EASD) Annual Meeting. rice field.

60% increased risk of type 1 diabetes at least 31 days after SARS-CoV-2 infection (hazard ratio adjusted) [HR]1.63) was found in the Norwegian study, whereas the Scottish study found increased risk only during the first few months of the 2020 pandemic, but importantly for a longer period (2020 2021).

Commenting on Twitter about the two studies presented at EASD, session moderator Kamlesh Khunti, MD, Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, UK, said: Type 1 diabetes due to COVID. ”

but new data research letter was announced in JAMA network openalso found that type 1 diabetes in children nearly doubled in the first months after infection with COVID-19 compared to infections with other respiratory viruses, based on US figures.

Dr Helen Colhoun, lead author of the Scottish study and Honorary Public Health Consultant for Public Health Scotland, commented:

That said, “it’s a very important issue and we shouldn’t drop the ball. [We must] Keep watching it and keep the scientific balance…[This] We emphasize the need to continue this analysis into the future to get a clear picture,” she emphasized.

Norwegian study: Small risk if relevant

Dr. German Tapia of the Norwegian Institute of Public Health in Oslo presented the results of a study on the risk of SARS-CoV-2 infection and subsequent type 1 diabetes among 1.2 million Norwegian children.

Of these, 424,354 children were infected with the COVID-19 virus and 990 cases of type 1 diabetes.

“What we do know about COVID-19 in children is that only a minority of children have mild symptoms and are hospitalized with more severe symptoms. We don’t know about the impact. Tapia adds that other viral infections are believed to be linked to the development of type 1 diabetes, particularly: respiratory infections.

Data are from Norway Emergency measures When you register for COVID-19, we collect daily data updates on infections (positive and negative results of free tests), diagnoses (primary and secondary care), immunizations (free), prescription drugs, underlying medical conditions, and more. population demographics.

“These data are linked using a personal identification number that every Norwegian citizen has,” explains Tapia.

He presented results from two cohorts. The first is for children only, including those tested for SARS-CoV-2 infection, and the second is for the entire Norwegian population cohort.

Regarding the first cohort, people under the age of 18 who tested positive for SARS-CoV-2 infection between March 2020 and March 2022 had a significant risk of type 1 diabetes at least 31 days after infection. and the adjusted hazard ratio was 1.63. (95% CI, 1.08–2.47; P. = .02). Adjustments were made for age, gender, non-Nordic origin, geographic region and socioeconomic factors.

The hazard ratio for children developing type 1 diabetes within 30 days of SARS-CoV-2 infection was 1.26 (95% CI, 0.72 – 2.19; P. = .42) and did not reach statistical significance.

“We know that type 1 diabetes develops over a long period of time, so it’s not surprising that fewer people develop type 1 diabetes within 30 days,” Tapia said.

“For this reason, we do not expect to find new cases of people developing type 1 diabetes within 30 days of being infected with COVID-19,” he explained. In these cases, “the most likely thing they already had was [type 1 diabetes]Type 1 diabetes was found because the infection likely caused the clinical symptoms. ”

Looking at the overall population cohort and diagnosis of type 1 diabetes over 30 days after SARS-CoV-2 infection, Norwegian researchers found a hazard ratio of 1.57 (95% CI, 1.06 – 2.33; P. = .03), the hazard ratio for diagnosis of type 1 diabetes within 30 days was 1.22 (95% CI, 0.72 – 2.19; P. = .42).

“The results were very similar and remained similar after adjusting for confounders,” reports Tapia.

He also performed a similar analysis of vaccination as exposure, but found no association between vaccination against SARS-CoV-2 and a diagnosis of type 1 diabetes.

“We conclude from these results that this suggests an increase in the diagnosis of type 1 diabetes after SARS-CoV-2 infection, although the absolute risk of most children developing type 1 diabetes after infection is We have to be careful that it’s low, we haven’t developed the disease,” he stressed.

“Norway has nearly half a million children infected with SARS-CoV-2, but only a small percentage of them develop type 1 diabetes.”

Scottish study: no long-term association

Colhoun and colleagues used electronic medical record linkage to examine the relationship between the incidence of type 1 diabetes and SARS-CoV-2 infection in Scottish children.

The study involved 1.8 million people under the age of 35 and found very weak, if any, evidence of an association between type 1 diabetes and SARS-CoV-2. Medscape Medical News Initially report These data are as of February 2022 when they were released as preprints.

Colhoun et al., who examined data from March 2020 to November 2021, found that 365,080 people aged up to 35 years who had at least one SARS-CoV-2 infection detected during follow-up had developed type 1 diabetes. We identified 1,074 people.

“In children under 16 years of age, 97% of suspected cases of type 1 diabetes are hospitalized and the date of diagnosis is recorded in the Scottish Care Information – Diabetes Collaboration register. [SCI-Diabetes] Before or within two days of first hospitalization for type 1 diabetes,” Colhoun said, emphasizing the timeliness of the data.

“We found that the incidence of type 1 diabetes diagnosis increased 1.2-fold in people aged 0–14 years, but the 30 days prior to diagnosis of type 1 diabetes showed an individual-level association with COVID-19 infection. No sex was found in this particular dataset,” she reported. Among young people aged 15 to 34, there was a linear increase in the incidence of type 1 diabetes from 2015 to 2021, with no increase in pandemics, she added.

Citing a 1.2-fold increase soon after the pandemic began, she explained that the increase in 0-14 year olds followed a decline in the months before the 2019 pandemic. Type 1 diabetes diagnoses remained roughly the same during the months of the pandemic, with typical peaks in February and September.

In the under-35 cohort, researchers also found a ratio of 2.62. [95% CI, 1.81 – 3.78] Within the 30-day window of SARS-CoV-2 infection, but beyond 30 days, there was no evidence of an association, with a ratio of 0.86. [95% CI, 0.62 – 1.21; P = .40]she reported.

She explained why a diagnosis of COVID-19 within 30 days is not considered causative. As with Tapia, Colhoun said the median time from symptom onset to her type 1 diabetes diagnosis was 25 days for her. “This suggests that 50% had symptoms for more than 25 days at diagnosis.

She also emphasized that when comparing the timing of SARS-CoV-2 testing and diagnosis, she found a much higher proportion of COVID-19 testing pre- and post-diagnosis. had to undergo a COVID-19 test.”

Latest US data points to link

On the other hand, for the new data reported, JAMA Network HealthEllen K. Kendall, a medical student at Case Western Reserve University School of Medicine in Cleveland, Ohio, matched 571,256 pediatric patients. Of those, 285,628 had his COVID-19 and 285,628 had a respiratory infection other than COVID-19.

By 6 months after COVID-19, 123 patients (0.043%) had a new diagnosis of type 1 diabetes, compared with 1 within 6 months after a non-COVID-19 respiratory infection. Only 72 (0.025%) were diagnosed with type diabetes.

At 1, 3, and 6 months post-infection, patients with SARS-CoV-2 had a higher diagnostic risk of type 1 diabetes compared with patients with respiratory infections other than COVID-19 (1 to 1). months: HR, 1.96; 3 months): HR, 2.10; and 6 months: HR, 1.83) and a subgroup of patients aged 0–9 years with a low-risk group type 2 diabetes.

“In this study, new type 1 diabetes diagnoses are more likely to occur in pediatric patients previously infected with COVID-19 than in pediatric patients with other respiratory infections (or encounters with other healthcare systems). was high,” say Kendall and co-authors.

“Respiratory infections have previously been associated with the development of type 1 diabetes, but this risk was even higher among COVID-19 patients in our study and among young people after long-term COVID-19. There is growing concern about autoimmune complications.”

“The increased risk of new-onset type 1 diabetes following COVID-19 adds an important consideration to the risk-benefit debate regarding prevention and treatment of SARS-CoV-2 infection in the pediatric population,” they conclude. attached.

a study From the U.S. Centers for Disease Control and Prevention (CDC) announced earlier this year, report To Medscape Medical Newsalso concluded that there was an association between COVID-19 and childhood diabetes, but not other acute respiratory infections. Children infected with SARS-CoV-2 were found to be 2.5 times more likely to be diagnosed with diabetes.

However, the study pooled all types of diabetes together and looked at other health conditions, medications that can raise blood sugar levels, race, obesityand other social determinants of health that may influence a child’s risk of contracting COVID-19 or diabetes.

“Even in people who had never been exposed to COVID-19 infection, the incidence of diabetes was 10 times the rate ever reported in the United States, so there is little doubt that the CDC data was wrong. No,” Colhoun said at EASD.

“This paper caused a great deal of panic, especially among people with children with type 1 diabetes, so we need to be very careful not to cause undue alarm until we have more conclusive evidence in this area.” there is.

But she also acknowledged that the new study in Norway was well conducted and has no methodological concerns about it, “I think we just have to wait and see.”

Given the inconclusiveness on this issue, the ongoing CoviDiab Registry We are collecting data on this subject.

EASD 2022. Announced on September 23, 2022. Abstracts 233 and 234.

Tapia published on behalf of lead author Gulseth, who reported no relevant financial relationships.Colhoun also has not reported any related financial relationships.

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