Incidence of Type 1 Diabetes in Children and Adolescents During the COVID-19 Pandemic in Germany: Results From the DPV Registry

Abstract

Objective: The aim of this study was to investigate the incidence of type 1 diabetes in children and adolescents during the Covid-19 pandemic in Germany compared to previous years. <br>Research Design and Methods: Based on data from the multicenter German Diabetes Prospective Follow-up Registry (DPV), we analyzed the incidence of type 1 diabetes per 100,000 patient years in children and adolescents from January 1, 2020, through June 30, 2021. Using Poisson regression models, expected incidences for 2020/21 were estimated based on the data from 2011 to 2019, and compared to observed incidences in 2020/21 by estimating incidence rate ratios (IRRs) with its 95% confidence interval (CI). <br>Results: From January 1, 2020, to June 30, 2021, 5,162 children and adolescents with new-onset type 1 diabetes in Germany were registered. The observed incidence in 2020/21 was significantly higher than the expected incidence (24.4 [95% CI, 23.6–25.2] vs. 21.2 [20.5–21.9]; IRR, 1.15 [1.10–1.20], p<0.001). IRRs were significantly elevated in June 2020 (IRR, 1.43 [1.07–1.90], p=0.003), July 2020 (IRR, 1.48 [1.12–1.96], p<0.001), March 2021 (IRR, 1.29 [95% CI, 1.01–1.65], p=0.028), and June 2021 (IRR, 1.39 [1.04–1.85], p=0.010). <br>Conclusions: A significant increase in the incidence of type 1 diabetes in children was observed during the Covid-19 pandemic, with a delay in the peak incidence of type 1 diabetes by approximately three months after the peak Covid-19 incidence and also after pandemic containment measures. The underlying causes are yet unknown. However, indirect effects of the pandemic are more likely to be the cause than direct ones.

Limited extent and consequences of pancreatic SARS-CoV-2 infection

“…In contrast, the proposition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as a trigger for new-onset diabetes has to contend with seemingly conflicting evidence regarding increased diabetes incidence rates during the COVID-19 pandemic as well as the considerable difficulties to distinguish an infectious diabetes origin from a multiplicity of pandemicrelated but indirect potential causalities (Barrett et al, 2022;Drucker, 2021;Ibrahim et al, 2021;Kamrath et al, 2022;Khunti et al, 2021;Sathish et al, 2021). Although the aggregate epidemiological evidence ostensibly argues against a direct diabetogenic potential of SARS-CoV-2 infection, this assessment is certainly provisional in consideration of the manifold ramifications of pandemic containment measures, the evolving landscape of clinical studies, various diagnostic challenges (e.g., a precise clinical definition of diabetes, previously undiagnosed type 1 or 2 diabetes [T1D or T2D, respectively]), the different pathophysiological mechanisms promoting acute and/ or prolonged glycometabolic perturbations (including hyperglycemia and insulin resistance typically associated with critical illness), and the possibility that a history of SARS-CoV-2 infection may alter diabetes incidence rates in the future (Al-Aly et al, 2021;Clarke et al, 2021;Drucker, 2021;Ibrahim et al, 2021;Jivanji et al, 2017;Kamrath et al, 2022;Li et al, 2020a;Misra et al, 2021;Montefusco et al, 2021;Reiterer et al, 2021). However, in the current context, a balanced evaluation of the available evidence also has to inform and delimit any speculation about the precise relevance of ex vivo and in vitro studies seeking to elucidate the potential for b cell infection, incapacitation, and/or destruction by SARS-CoV-2 (Accili, 2021;Atkinson and Powers, 2021).…”

Glycated hemoglobin at diagnosis of type 1 diabetes and at follow‐up in children and adolescents during the COVID ‐19 pandemic in Germany

“…9,10 It has been demonstrated that the incidence of type 1 diabetes in children increased only a few months after the Covid-19 waves. 11,12 With this background, it is important to note that we found an increased insulin requirement in children with onset of type 1 diabetes after the first wave of the Covid-19 pandemic. This may indicate more rapid autoimmune destruction of beta cells during the pandemic.…”

Type 1 diabetes incidence increased during the COVID ‐19 pandemic years 2020–2021 in Czechia: Results from a large population‐based pediatric register

“…Only few formally explored trends originating from long-term run population based registers. 8,9 Recently, studies have been published that utilized big collections of electronic health records or medical claims, reporting conflicting results. [10][11][12] We therefore explored the data of Czech Childhood Diabetes Register, examining data ascertained over 2020-2021 when Czechia was very severely hit by several consecutive waves of COVID-19, and compared them to trends from the previous decade, also searching for patterns explainable by the dynamics of the pandemic, or by pandemic contingency measures.…”