COVID-19 infection didn’t appear to precipitate a diagnosis of type 1 diabetes in kids, a prospective multinational cohort study suggested.
Researchers tested more than 4,500 adolescents every few months for type 1 diabetes, SARS-CoV-2 infection, and vaccination antibodies from January 2020 through December 2021. However, there was no difference among the 45 kids diagnosed with type 1 diabetes during this time when it came to COVID-19 infection history, reported Jeffrey Krischer, PhD, of the University of South Florida in Tampa, and colleagues.
According to the correspondence published in the New England Journal of Medicine, five of these children were diagnosed with type 1 diabetes prior to testing positive for SARS-CoV-2 nucleocapsid antibodies. One child was diagnosed with diabetes after a COVID infection.
As 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 prior to type 1 diabetes diagnosis, four were vaccinated after the diagnosis, and three were not tested.
“COVID infections or vaccinations are not implicated in promoting type 1 diabetes in adolescents,” Krischer told MedPage Today.
“There have been many articles from around the world that have noted an increase in the number of type 1 diabetes cases comparing the pre-pandemic years to the pandemic years,” he said. “While the authors concluded that the increase was due to COVID, none of the studies included systematic COVID testing.”
Several studies released over the past few years suggested a link between COVID-19 infection and development of diabetes, particularly in children. Early in 2022, CDC data indicated that kids who tested positive for COVID had more than a two-fold higher risk for developing new-onset diabetes — type 1, type 2, and other types of diabetes — compared with those with other respiratory infections.
Other studies looking specifically at type 1 diabetes showed a similarly elevated risk compared with other respiratory infections, as well as a higher incidence of type 1 diabetes diagnoses in children during the pandemic.
“The increase in the number of cases seen during the pandemic was due to other factors,” Krischer explained. “It might have been the result of enhanced monitoring for the disease or more rapid clinical presentations — for example, cases that would have been diagnosed later, but were diagnosed earlier because of symptoms.”
“We wanted to know the extent of COVID infections and vaccinations among children,” he added. “The TEDDY project is investigating possible causes of type 1 diabetes and this would be an important finding, as there is much speculation about an infectious origin of the disease.”
While an infectious origin of type 1 diabetes is still being debated, there are “theoretical biologic reasons why COVID could be such an agent,” he noted.
However, despite this possibility, the current study found no evidence to suggest a link between the two.
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.
Looking specifically at the kids without islet autoantibodies, only 1% (40 kids) experienced seroconversion to persistent and confirmed positivity for islet autoantibodies. Of these 40 kids, only five had nucleocapsid antibodies — which appeared after seroconversion. The other 35 kids never tested positive for nucleocapsid antibodies.
That being said, 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.
During the study, kids were tested every 6 months for type 1 diabetes if they didn’t have islet autoantibodies. Those who did were tested every 3 months. All kids were tested for COVID infection and spike antibodies (indicating vaccination) at every follow-up visit. During the 2-year study, children were seen either four or eight times depending on if they had islet autoantibodies.
Participants were located in the U.S., Finland, 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%).
The narrow age range of children included in the study was a limitation, Krischer and colleagues noted.
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Disclosures
Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, the CDC, the Juvenile Diabetes Research Foundation, and National Center for Advancing Translational Sciences awards to the University of Florida and the University of Colorado.
Krischer reported no disclosures. Other study authors reported relationships with Prevention Bio, Sanofi, Diamyd Medical AB, and Janssen, and holding type 1 diabetes-related patents.
Primary Source
New England Journal of Medicine
Source Reference: Krischer JP, et al “SARS-CoV-2 — no increased islet autoimmunity or type 1 diabetes in teens” N Engl J Med 2023; DOI: 10.1056/NEJMc2216477.
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