Is the T1D risk in children greater with COVID than with other respiratory infections?

Children with previous COVID-19 infection appeared to be more likely to develop type 1 diabetes (T1D) compared to those who had had other respiratory infections during the pandemic, a cohort study found.

In this propenity score-matched analysis involving more than 500,000 pediatric patients, the risk of a new T1D diagnosis was higher in those previously infected with SARS-CoV-2 than in other respiratory infections at the following time points after infection :

  • 1 month: HR 1.96 (95% CI 1.26-3.06)
  • 3 months: HR 2.10 (95% CI 1.48-3.00)
  • 6 months: HR 1.83 (95% CI 1.36-2.44)

Similar risks were seen for the SARS-CoV-2 group compared to other control cohorts exposed to the health care system at 6 months, such as those who attended child welfare visits (HR 2.10, 95% CI 1.61-2.73 ) and those who had fractures (HR 2.09, 95% CI 1.41-3.10), Rong Xu, PhD, of the Case Western Reserve University School of Medicine in Cleveland, and colleagues reported in a research letter published in JAMA network opened.

In a subgroup analysis that divided the children into two age groups – from 0 to 9 years and from 10 to 18 years – a higher risk was noted at 6 months for both groups:

  • Ages 0-9: HR 1.73 (95% CI 1.02-2.94)
  • 10-18 years: HR 2.18 (95% CI 1.57-3.03)

“Respiratory infections have been previously associated with the onset of T1D, but this risk was even greater in those with COVID-19 in our study, raising concerns about long-term, post-COVID-19 autoimmune complications in young people they wrote.

“The increased risk of newly emerging T1D after COVID-19 adds an important consideration to the risk-benefit discussions for prevention and treatment of SARS-CoV-2 infection in pediatric populations,” they concluded.

A spike in T1D cases was seen in children during the pandemic, Xu’s group noted. The CDC reported that children diagnosed with SARS-CoV-2 were more likely to develop diabetes but did not differentiate between type 1 and type 2. However, other studies have suggested more evidence is needed to confirm the link.

“COVID-19 can have significant impacts on multiple organ systems in children, including the pancreas and the immune system,” Xu said. MedPage today.

As for the next steps in the study, “First, we want to follow the cohorts longer to see if the increased risk of T1D is transient or persistent,” noted Xu. “Second, [we would like to] quickly evaluate whether existing drugs (e.g., antivirals, anti-inflammatory drugs) can be reused to treat COVID-19-associated T1D.”

“Third, we need to examine whether COVID-19-induced T1D is different from traditional T1D,” he added. “Fourth, we want to investigate whether COVID-19 is also associated with new diagnoses of type 2 diabetes in children.”

For this study, Xu and colleagues examined electronic health record data from the Global Collaborative Network on 1,091,494 pediatric patients with COVID-19 (n=314,917) or non-COVID respiratory infections (n=776,577) at 74 centers in 50 US states and 14 countries from March 2020 to December 2021. They matched 285,628 patients from each infection group 1:1 for family history of diabetes and demographics. Patients were further divided into younger and older age groups.

The mean patient age was 9 in both groups after matching. More than half of all patients were white and half were boys. Only 1-2% had a family history of diabetes.

At 6 months post-infection, 0.04% of the COVID-19 group was newly diagnosed with T1D compared to 0.03% of the non-COVID group.

Xu and colleagues noted the observational, retrospective design of their study, which may have introduced bias. In addition, the use of electronic health records increased the risk of diagnostic misclassification.

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    Zaina Hamza is a staff writer for MedPage Today, on gastroenterology and infectious diseases. She is based in Chicago.

disclosures

This study was supported by grants from the Clinical and Translational Science Collaborative of Cleveland, the National Institute on Aging, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse.

Xu reported no conflict of interest.

A co-author reported funding from the National Institutes of Health.

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