New‐onset type 1 diabetes in children and adolescents as postacute sequelae of SARS‐CoV‐2 infection: A systematic review and meta‐analysis of cohort studies

Rahmati, Masoud; Yon, Dong Keon; Lee, Seung Won; Udeh, Raphael; McEvoy, Mark; Kim, Min Seo; Gyasi, Razak M.; Oh, Hans; Sánchez, Guillermo Felipe López; Jacob, Louis; Li, Yusheng; Koyanagi, Ai; Smıth, Lee

doi:10.1002/jmv.28833

Cited by 24 publications

(6 citation statements)

References 37 publications

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“…Furthermore, Bellia et al’s [ 12 ] focus on the prevalence, rather than the incidence, of new-onset diabetes further narrows the scope of the study and limits its applicability in understanding the full extent of diabetes burden in patients with long COVID. The study conducted by Rahmati et al [ 14 ] is notable for its inclusion of both acute and patients with long COVID, potentially obscuring the unique risks and outcomes associated with the prolonged phase of COVID-19. The study by Banerjee et al [ 11 ] comprised a small number of studies (n=7), potentially constraining the statistical power of the subgroup analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Previous systematic reviews examining the incidence and excess risk of new-onset diabetes in patients with long COVID (compared to individuals without COVID-19) are subject to several limitations. These limitations include the inclusion of new-onset diabetes cases that occurred during both the acute and post–COVID-19 phases [ 14 ], a small number of studies included in the meta-analysis [ 11 , 14 , 15 ], reliance solely on a single definition for COVID-19 diagnosis (such as the International Classification of Diseases, Tenth Revision [ ICD-10 ] codes) [ 16 ], the absence of meta-analysis [ 13 ], and a focus limited to a specific type of diabetes [ 14 ]. Moreover, none of these studies have provided data on the clinical trajectory of new-onset diabetes cases or quantified the impact of COVID-19 as a risk factor for new-onset diabetes during the long COVID phase.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, Risk, and Clinical Course of New-Onset Diabetes in Long COVID: Protocol for a Systematic Review and Meta-Analysis of Cohort Studies

Talanki,

Bajaj,

Trehan

et al. 2024

JMIR Res Protoc

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Background COVID-19, an infectious disease pandemic, affected millions of people globally, resulting in high morbidity and mortality. Causing further concern, significant proportions of COVID-19 survivors endure the lingering health effects of SARS-CoV-2, the pathogen that causes COVID-19. One of the diseases manifesting as a postacute sequela of COVID-19 (also known as “long COVID”) is new-onset diabetes. Objective The aim of this study is to examine the incidence of new-onset diabetes in patients with long COVID and assess the excess risk compared with individuals who tested negative for COVID-19. The study also aims to estimate the population-attributable fraction for COVID-19 as a risk factor for new-onset diabetes in long COVID and investigate the clinical course of new-onset diabetes cases. Methods This is a protocol for a systematic review and meta-analysis. PubMed, MEDLINE, Embase, Scopus, and Web of Science databases will be systematically searched to identify articles published between December 2019 and July 2024. A comprehensive search strategy for each database will be developed using a combination of Medical Subject Headings terms, subject headings, and text words to identify eligible studies. Cohort studies and randomized controlled trials (only control arms) involving patients with COVID-19 of any age, with follow-up data on new-onset diabetes in long COVID, will be considered for inclusion. Controls will comprise individuals who tested negative for COVID-19, with or without other respiratory tract infections. Three independent reviewers (AST, NB, and TT) will perform article selection, data extraction, and quality assessment of the studies. A fourth reviewer (ST) will review the identified studies for final inclusion in the analysis. The random-effects DerSimonian-Laird models will be used to estimate the pooled incidence proportion (%), incidence rate of diabetes (per 1000 person-years), and risk ratio (with 95% CIs) for diabetes incidence. Results A total of 1972 articles were identified through the initial search conducted in August 2023. After excluding duplicates, conducting title and abstract screening, and completing full-text reviews, 41 articles were found to be eligible for inclusion. The search will be updated in July 2024. Currently, data extraction is underway, and the meta-analysis is expected to be completed in August 2024. Publication of the study findings is anticipated by the end of 2024. Conclusions The study findings should provide valuable insights to inform both clinical practice and public health policies regarding the effective management of new-onset diabetes in patients with long COVID. International Registered Report Identifier (IRRID) DERR1-10.2196/54853

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence, Risk, and Clinical Course of New-Onset Diabetes in Long COVID: Protocol for a Systematic Review and Meta-Analysis of Cohort Studies

Talanki,

Bajaj,

Trehan

et al. 2024

JMIR Res Protoc

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“…The TriNetX platform has been used extensively in both adult and pediatric patient populations to report epidemiological outcomes and risk assessments in an array of pathologic settings. 13 – 15 This study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. 16 Description of the database is further laid out in the Supplemental Methods .…”

Section: Methodsmentioning

confidence: 99%

Epidemiology, Risk Factors, and Clinical Outcomes of AKI in Pediatric Hematopoietic Stem Cell Transplant Patients

Ashruf,

Orozco

et al. 2024

Kidney360

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Key Points The cumulative incidence of AKI diagnosis post–hematopoietic stem cell transplantation was 12.9%. Calcineurin inhibitor use was associated with the highest cumulative incidence, 21.6%, after hematopoietic stem cell transplantation.Patients with AKI with hypertension/hypertensive disease had a 30-day survival probability of 63.9% (hazard ratio, 4.86, 95% confidence interval, 3.58 to 6.60).Patients with AKI were 2.5 times more likely to experience composite hospitalization and/or mortality at 30 days. Of patients who developed AKI, dialysis dependence has nearly tripled since 2014. Background AKI is a common complication in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT), with a reported prevalence ranging from 68% to 84%. Few multicenter pediatric studies comprehensively assess the epidemiologic associations and clinical outcomes associated with AKI development. Methods An observational, retrospective analysis was conducted using an aggregated electronic health record data platform. The study population consisted of pediatric patients (age <18 years) who underwent HSCT over a 20-year period. The study groups consisted of patients with an encounter diagnosis of AKI (n=713) and those without AKI (n=4455). Both groups were propensity matched for age, sex, race, prior cancer diagnosis, and other comorbidities. End points were incidence, mortality risk, clinical outcomes, and prevalence of dialysis dependence. Competing risks analysis, Cox proportional hazard analyses, Kaplan–Meier survival curves, and incidence/prevalence rates were calculated. Results After matching, 688 patients were identified. Cumulative incidence of AKI diagnosis post-HSCT was 13.7%. Hypertensive disease, calcineurin inhibitors, and vancomycin were the most prevalent risk factors for AKI, with calcineurin inhibitors showing the highest cumulative incidence (21.6%). Patients with AKI with hypertensive disease had a survival probability of 63.9% at 30 days, followed by calcineurin inhibitors (64.4%) and vancomycin (65.9%). Patients with AKI were 1.7 times more likely to experience composite hospitalization and/or mortality at 30 days. At 365 days post-HSCT, patients with AKI had higher rates of all-cause emergency department visits, intensive care unit admissions, and mechanical ventilation compared with non-AKI. Of patients who developed AKI, the prevalence of dialysis dependence has nearly tripled since 2014. Conclusions The findings highlight a strong association between specific risk factors, such as hypertension, calcineurin inhibitor use, and vancomycin use, with increased mortality and adverse clinical outcomes in patients with AKI after HSCT. These results emphasize the need for preventative actions such as 24-hour BP monitoring and discontinuation of potential nephrotoxic medications.

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“…Their analysis revealed that the COVID-19 pandemic led to a 9.5% increase in global new-onset T1D cases among pediatric populations, the global number of children experiencing DKA and severe DKA increased by 9.5%, 25%, and 19.5%, respectively, when compared to pre-COVID-19 years [ 19 ]. In separate meta-analysis from other countries and time periods, it was also demonstrated that the risk of new-onset T1DM and DKA following COVID-19 infection in children and adolescents was higher compared to non-COVID-19 control groups [ 20 – 22 ].…”

Section: Epidemiologymentioning

confidence: 99%

Covid 19 and diabetes in children: advances and strategies

Wu,

Wang,

Ullah

et al. 2024

Diabetol Metab Syndr

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Background Throughout the COVID-19 pandemic, there has been a notable increase in the incidence of new-onset diabetes and diabetic ketoacidosis (DKA). Simultaneously, children diagnosed with type 1 diabetes (T1D) have encountered difficulties in maintaining optimal blood glucose levels. The mechanisms underpinning these correlations still remain a puzzle. We reviewed the studies that examined changes in incidence during the pandemic. These studies utilized various metrics for comparison, which encompassed the timing of data collection, diagnostic criteria, as well as the numbers and incidence rates of diabetes and DKA. We found the incidence of diabetes and DKA was higher during the pandemic. As to mechanisms, the invivo and invitro study revealed the factors such as direct viral damage, metabolic dysfunction, and immune responses all attribute to the process of T1D after suffering from COVID-19. Furthermore, we provide some useful strategies to prevent and treat children suffering from diabetes and COVID-19. Conclusions: Strong correlations have been observed between new-onset diabetes and COVID-19. Insights gleaned from clinical descriptions and basic research can offer valuable experience and recommendations for the treatment and prevention of diabetes during future pandemics.

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New‐onset type 1 diabetes in children and adolescents as postacute sequelae of SARS‐CoV‐2 infection: A systematic review and meta‐analysis of cohort studies

Cited by 24 publications

References 37 publications

Incidence, Risk, and Clinical Course of New-Onset Diabetes in Long COVID: Protocol for a Systematic Review and Meta-Analysis of Cohort Studies

Incidence, Risk, and Clinical Course of New-Onset Diabetes in Long COVID: Protocol for a Systematic Review and Meta-Analysis of Cohort Studies

Epidemiology, Risk Factors, and Clinical Outcomes of AKI in Pediatric Hematopoietic Stem Cell Transplant Patients

Covid 19 and diabetes in children: advances and strategies

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