Increased Incidence of Type 1 Diabetes during the COVID-19 Pandemic in Romanian Children

Abstract

Background and Objective: It is known that several viruses are involved in the pathogenesis of type 1 diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new worldwide spread virus that may act as a trigger for the autoimmune destruction of the β-cells, as well, and thus lead to an increase in the incidence of type 1 diabetes. Material and Methods: The Romanian National Organization for the Protection of Children and Adolescents with Diabetes (ONROCAD) has collected information regarding new cases of type 1 diabetes in children aged 0 to 14 years from all over the country since 1996 and has computed the incidence of type 1 diabetes in this age group. Results: We observed a marked increase in the incidence of type 1 diabetes in the first year of the COVID-19 pandemic, with 16.9%, from 11.4/100,000 in 2019 to 13.3/100,000 in 2020, much higher compared to previous years (mean yearly increase was 5.1% in the period 1996–2015 and 0.8% in the interval 2015–2019). The proportion of newly diagnosed cases was significantly higher in the second half of 2020 compared to the second half of the previous years (57.8 vs. 51%, p < 0.0001). Conclusions: All these aspects suggest the role that SARS-CoV-2 could have in triggering pancreatic autoimmunity. To confirm this, however, collecting information from larger populations from different geographical regions, monitoring the incidence curves over a period of several years, and gathering background information on COVID-19 and/or data on COVID-19 specific antibodies are needed.

Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years — United States, March 1, 2020–June 28, 2021

“…Evidence of increased pediatric type 1 diabetes has been reported during the COVID-19 pandemic (1,2). Among † † † † https://www.cdc.gov/media/releases/2019/p1202-diabetes.html § § § § h t t p s : / / w w w. c d c .…”

“…Evidence of increased pediatric type 1 diabetes has been reported during the COVID-19 pandemic ( 1 , 2 ). Among persons aged <18 years with COVID-19 and new diabetes diagnoses in this study, nearly one half had DKA at or around the time of diagnosis.…”

“…The COVID-19 pandemic has disproportionately affected people with diabetes, who are at increased risk of severe COVID-19. * Increases in the number of type 1 diabetes diagnoses ( 1 , 2 ) and increased frequency and severity of diabetic ketoacidosis (DKA) at the time of diabetes diagnosis ( 3 ) have been reported in European pediatric populations during the COVID-19 pandemic. In adults, diabetes might be a long-term consequence of SARS-CoV-2 infection ( 4 – 7 ).…”

Relation of incident Type 1 diabetes to recent COVID-19 infection: cohort study using e-health record linkage in Scotland

“…Of the 33/84 new cases during the pandemic who were tested for SARS-CoV-2 IgG, all were negative suggesting a cause other than COVID-19 itself A Romanian registry also reported a temporal increase in incident T1D during the pandemic period of 13.3/100,000 compared to 11.0-12.3/100,000 for the 2015-2019 period. [23]. In contrast, studies from Germany [24], Saudi Arabia [25] and Italy [26] have found incidence to be no higher during the pandemic than before.…”

SARS-CoV-2 Infection and Pancreatic β Cell Failure

“…In contrast, Hollstein et al [ 55 ] reported a case of type 1 diabetes, in which the disease had developed five to seven weeks after SARS-CoV-2 infection, without the presence of islet-related autoantibodies. Furthermore, an increased number of new-onset type 1 diabetes cases in children was observed after the initial COVID-19 outbreak in the United Kingdom [ 14 ] and Romania [ 56 ]. In addition, COVID-19 may induce diabetic ketoacidosis (DKA) and pancreatitis in some patients [ 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ], suggesting that COVID-19 may induce pancreatic tissue damage and disrupt glycometabolic control.…”