Did the COVID-19 Lockdown Affect the Incidence of Pediatric Type 1 Diabetes in Germany?

Expression of SARS-CoV-2 Entry Factors in the Pancreas of Normal Organ Donors and Individuals with COVID-19

“…Further work will be needed to precisely quantify the fractions and expression levels of ACE2 by islet endocrine cells in these islet preparations, to evaluate possible modulation of ACE2 by the prolonged and varied islet handling requirements (e.g., isolation, culture under different conditions, dispersion), to define the exact role of ACE2 in mediating SARS-CoV-2 infection in vitro and in vivo using extended islet xenotransplantation approaches, and to interrogate the precise relation of scarce ACE2 expression and immunopathology as most recently demonstrated for the lung in a manuscript available for public review ( Hönzke et al., 2020 ). Beyond this, contrasting epidemiological reports from the United Kingdom and Germany ( Tittel et al., 2020 ; Unsworth et al., 2020 ) not only underscore the requirement for data on diabetes incidence and SARS-CoV-2 infection rates in defined populations over time, but in addition raise the need for studying pancreatic tissues from donor cohorts of different demographics, ethnicities, and geographic populations. Indeed, it is possible that COVID-19 may cause an upregulation of ACE2 in endocrine or other cell types, but as of yet, gene and protein expression levels cannot be reliably quantified from autopsy tissues due to pancreatic autolysis and the relative scarcity of high-quality pancreas tissues obtained from SARS-CoV-2-infected individuals.…”

COVID-19 and diabetes mellitus: from pathophysiology to clinical management

“…These contradictory findings might be explained by the small patient numbers analysed: they could have been down to chance, or they could be caused by changes in the availability of medical services during the COVID-19 pandemic. A population-based study from Germany found no deviation from the projected numbers of newly diagnosed paediatric patients with T1DM 129 . However, the same study found a statistically significant increase in diabetic ketoacidosis and severe ketoacidosis in children and adolescents presenting with new-onset T1DM 130 .…”

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…As viral infections have been associated with increased reports of T1D, the putative relationship between SARS-CoV-2 infection and the incidence rates of T1D continues to receive scrutiny. Nevertheless, reports from several centers do not support an increased incidence of new-onset T1D comparing historical rates with those from the recent pandemic period ( Lawrence et al., 2021 ; Tittel et al., 2020 ). Analysis of incident diabetes rates reported by 216 German pediatric diabetes centers from March 13 to May 13 each year from 2011 to 2020 in children and adolescents <18 years of age revealed no relative increase in cases reported in 2020 ( Tittel et al., 2020 ).…”

“…Nevertheless, reports from several centers do not support an increased incidence of new-onset T1D comparing historical rates with those from the recent pandemic period ( Lawrence et al., 2021 ; Tittel et al., 2020 ). Analysis of incident diabetes rates reported by 216 German pediatric diabetes centers from March 13 to May 13 each year from 2011 to 2020 in children and adolescents <18 years of age revealed no relative increase in cases reported in 2020 ( Tittel et al., 2020 ). Moreover, retrospective analysis demonstrates that rates of hospitalization for 2,336 Belgian subjects with T1D do not appear to be increased from February 1 to April 30, 2020, relative to hospitalization numbers for individuals without T1D ( Vangoitsenhoven et al., 2020 ).…”