A recent study published in the Journal of American Medical Association (JAMA) assessed the incidence and risk of type 1 diabetes in children with coronavirus disease 2019 (COVID-19).
Study: Type 1 Diabetes Incidence and Risk in Children With a Diagnosis of COVID-19. Image Credit: antoniodiaz/Shutterstock.com
Type 1 diabetes incidence has increased among children throughout the COVID-19 pandemic. Still, studies have not differentiated between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected and non-infected children.
Claims for statutorily insured patients in Bavaria are processed by the Bavarian Association of Statutory Health Insurance Physicians (BASHIP), covering around 85% of the population.
The study and findings
The present study evaluated a population-based patient dataset of COVID-19 diagnoses to assess associations between type 1 diabetes and COVID-19 in Bavarian children. The researchers used anonymized BASHIP data on children born during 2010-18 recorded until December 2021 for analysis.
Diagnoses of type 1 diabetes and COVID-19 based on the International Classification of Diseases, Tenth Revision (ICD-10) codes were recorded in three-month intervals without the exact dates of diagnoses. Clinicians provided codes about whether COVID-19 diagnosis was confirmed by a positive reverse-transcription polymerase chain reaction (RT-PCR) test.
The researchers compared incidence rates of type 1 diabetes in 2019-19 and 2020-21. They used Cox models to assess the association between type 1 diabetes risk and COVID-19 diagnosis quarterly in 2020-21. Models were adjusted for the age and sex of the children. Additionally, the team performed a sensitivity analysis restricted to confirmed COVID-19 cases.
Of more than 1.18 million children with claims data in the BASHIP database, type 1 diabetes was diagnosed in 1,242 children until December 2021. Over 195,000 children from January 2020 to December 2021 had COVID-19 diagnoses. COVID-19 incidence was 0.18% between January and March 2020, which increased to 4.8% between October and December 2021.
COVID-19 incidence was higher in children < 6.5 years; boys had higher COVID-19 incidence than girls. Type 1 diabetes incidence rate was 19.5 and 29.9 per 100,000 person-years during 2018-19 and 2020-21, respectively. The incidence rate was 28.5 per 100,000 person-years during the COVID-19 pandemic without prior or concurrent SARS-CoV-2 infection. By contrast, it was 55.2 per 100,000 person-years in the quarter of COVID-19 diagnosis.
Further, the incidence rate of type 1 diabetes within six months and 6-15 months post-COVID-19 diagnosis quarter was 38.8 and 50.7 per 100,000 person-years, respectively. The hazard ratio for developing type 1 diabetes in 2020-21 was 1.57 without COVID-19 and 1.69 when confirmed COVID-19 cases were included, after adjusting for children's age and sex.
In summary, COVID-19 diagnosis has been associated with a higher type 1 diabetes incidence in children in Bavaria since 2020.
The results suggest a contribution of SARS-CoV-2 infection to the elevated incidence of type 1 diabetes during the COVID-19 pandemic. Further, undiagnosed SARS-CoV-2 infections may have contributed to the slight increase in type 1 diabetes incidence among those without COVID-19.
The team could not determine whether diabetes was diagnosed pre- or post-COVID-19. Moreover, confirmed COVID-19 status was unavailable for most cases. Besides, potential selection bias and confounding could not be ruled out.
Overall, future studies should determine if children at risk of type 1 diabetes should be vaccinated.