Incidence increase of type 1 diabetes in children and adolescents during the pandemic
Question: If the number of new cases of type 1 diabetes among children and adolescents in Germany increases during the COVID 19 pandemic?
For COVID-19-induced autoimmunity against pancreatic beta cells to develop in children and adolescents would take years. Therefore, this option is more likely not to be the cause of type 1 diabetes manifesting shortly after illness.
Background: The occurrence of type 1 diabetes as an autoimmune disease is influenced by genetic and environmental factors that can trigger an autoimmune response. There is much evidence for the importance of infections, particularly respiratory. It is suspected that SARS-CoV-2 infections may also contribute to the manifestation of type 1 diabetes in. However, it is unknown whether this causes an increase in incidence. During the course of the corona pandemic. A variety of containment measures would be taken. As a side effect, this led to a significant decrease in respiratory infections in children and adolescents. An initial publication from the Diabetes Patient History (DPV) registry revealed no increase in incidence of type 1 diabetes during the first wave of corona in spring 2020.
Patients and Methods: The DPV database currently captures more than 90% of all children and adolescents with type 1 diabetes nationally. For the current analysis, manifestations of the 1.1.2020 to 30.6.2021 compared with manifestations from 2011 to 2019. Pandemic level was represented by weekly incidences during the study period. The analysis was performed for the total period. For 5 different time periods depending on pandemic activity. In the analyzed period of the pandemic, 5.162 children. Adolescents with manifestations of type 1 diabetes enrolled in DPV.162 children and adolescents with manifestation of type 1 diabetes registered in DPV. An increase in manifestations compared to 2018/19 will be visible starting in calendar week 20 of 2020. 2011-2019, a mean annual increase in incidence of 2.4% is seen with a boy turnout. Comparing the incidence during the pandemic years with the expected incidence for these years calculated according to the incidences of the previous years shows a significantly higher incidence in 2020/21 with 24.4 (95% CI 23.6-25.2) than would be expected (21.2, 95% CI 20.5-21.9). The adjusted incidence ratio rate (IRR) is 1.15. Interestingly, this increase in incidence for the children was
Conclusion: With a time lag of 3 months to the maximum incidence of SARS-CoV-2 infections in Germany, a significant increase in the incidence of type 1 diabetes in children and adolescents was documented. The causes are unknown. The authors suspect indirect effects rather than a direct impact of the pandemic.
Kamrath C, Rosenbauer J, Eckert AJ et al. Incidence of Type 1 Diabetes in Children and Adolescents During the COVID-19 Pandemic in Germany: Results From the DPV Registry. Diabetes Care. 2022 Jan 17;dc210969. https://doi.org/10.2337/dc21-0969
Comment by PD Dr. med. Thomas Kapellen
Direct influence of SARS-CoV-2 currently rather unlikely
There are now more or less good publications worldwide on the question of incidence increase. Data recently published in the U.S. from hospital registries analyzed diabetes cases in children and adolescents and did not distinguish between type 1 and type 2 diabetes. This analysis has been viewed critically by many professional societies. In Europe, there are data from Italy that showed an increase in type 1 diabetes incidence in Lombardy, but this did not reach significance. In Finland, on the other hand, significantly more manifestations were seen during the first year of the pandemic with a smaller number of cases at the Helsinki University Hospital . A very recent study from San Diego/USA also shows a significant increase of manifestations in 2020/21 for this center . Basically, one has to discuss both the possibility of direct effects in terms of a trigger by SARS-CoV-2 infections, which is indeed known for other viral infections, and the possibility of indirect effects due to measures and consequences from the pandemic. Measures of the pandemic do include consequences such as an increase in body mass index and physical inactivity (which could explain an increase in incidence), or a reduced number of respiratory infections as a possible trigger (this would tend to explain a lower incidence). On the other hand, SARS-CoV-2 infections in children. children and adolescents often go undiagnosed or with mild symptoms. SARS-CoV-2 infection as the basis of autoimmunity then developing is unlikely, as such autoimmune processes take years to develop before symptoms appear. There is conflicting evidence for a direct attack of SARS co-virus 2 on beta cells, so this mechanism is also rather unlikely. Unfortunately, there is insufficient information on infection status in the DPV database. Isolation and segregation create possible additional risks for the development or worsening of autoimmune disease. It is also known through various studies that psychological well-being decreased during the pandemic in children. Psychological stress is also an important factor influencing our immune system.