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Is T1D Risk in Kids Greater With COVID Than Other Respiratory Infections?

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

In this propensity score-matched analysis involving over 500,000 pediatric patients, risk of a new T1D diagnosis was higher among those who had been previously infected with SARS-CoV-2 versus 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 when compared with other control cohorts who had encounters with the healthcare system at 6 months, such as those who attended child-wellness visits (HR 2.10, 95% CI 1.61-2.73) and those who had fractures (HR 2.09, 95% CI 1.41-3.10), reported Rong Xu, PhD, of Case Western Reserve University School of Medicine in Cleveland, and colleagues in a research letter published in JAMA Network Open.

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

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

“Respiratory infections have previously been associated with onset of T1D, but this risk was even higher among those with COVID-19 in our study, raising concern for long-term, post-COVID-19 autoimmune complications among youths,” they wrote.

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

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

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

As far as next steps in research go, “first, we would like to follow the cohorts for a longer time to see if the increased risk of T1D is transitory or persistent,” Xu noted. “Second, [we would like to] quickly evaluate if existing drugs (e.g., antivirals, anti-inflammatory drugs) can be repurposed to treat COVID-19-associated T1D.”

“Third, we need to investigate if COVID-19-triggered T1D is different from traditional T1D,” he added. “Fourth, we would like to examine if 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 who had COVID-19 (n=314,917) or non-COVID respiratory infections (n=776,577) across 74 centers in 50 U.S 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.

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

At 6 months after infection, 0.04% of the COVID-19 group received a new diagnosis of T1D compared with 0.03% the non-COVID group.

Xu and colleagues noted the observational, retrospective design of their study, which may have introduced potential bias. Additionally, the use of electronic health records added to the risk of diagnostic misclassification.

  • Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. 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 conflicts of interest.

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

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