Risk of Type 1 Diabetes in Children is Not Increased after SARS-CoV-2 Infection: A Nationwide Prospective Study in Denmark

Abstract

Objective It has been hypothesized that SARS-CoV-2 infection in children can increase risk of developing type 1 diabetes. Research Design and Methods We undertook a prospective analysis based on all children in Denmark where we investigated the association between SARS-CoV-2 infection and subsequent risk of type 1 diabetes, using information from several different national Danish registers. Denmark had one of the highest test-rates per capita in the world during the pandemic. Results We did not observe a higher risk of a first time diagnosis of type 1 diabetes in children 30 days or more after a positive SARS-CoV-2 test, compared to children with a history of only negative SARS-CoV-2 tests (Hazard ratio 0.85, 95% CI 0.70, 1.04). Conclusions Our data do not support that SARS-CoV-2 infection is associated with type 1 diabetes, or that type 1 diabetes should be a special focus after a SARS-CoV-2 infection in children.

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

“…Seven reports from six studies 2,3,5–8 involving 11 220 476 participants (2 140 864 patients with a history of diagnosed SARS‐CoV‐2 infection and 9 079 612 participants in the respective control groups) reported numbers of new‐onset T1DM following SARS‐CoV‐2 infection. Overall, SARS‐CoV‐2 infection was significantly associated with an increase in the risk of new‐onset T1DM in children and adolescents compared with non‐COVID‐19 control groups (RR = 1.42, 95% CI 1.13–1.77, p = 0.002).…”

“…SARS‐CoV‐2 infection was defined by first positive PCR test for SARS‐CoV‐2 in all included studies. The control group in six studies was from non‐COVID‐19 participant 2–4,6–8 and in one study selected from patients with other respiratory tract infections 5 . Studies reported the risk of new‐onset T1DM based on adjustment for age, 3,8 gender, 3,7,8 geographical area and socioeconomic factors, comorbidity, vaccine doses, parental history of T1DM, 7 and calendar time 6,7 .…”

“…All meta-analyses in the current study were conducted using Review Manager (version 5.4; The Nordic Cochrane Center) and a two-sided p value less than 0.05 was considered statistically significant. was from non-COVID-19 participant [2][3][4][6][7][8] and in one study selected from patients with other respiratory tract infections. 5 Studies reported the risk of new-onset T1DM based on adjustment for age, 3,8 gender, 3,7,8 geographical area and socioeconomic factors, comorbidity, vaccine doses, parental history of T1DM, 7 and calendar time.…”

“…Importantly, Zhang and colleagues conducted their meta-analysis based on including only two studies for children and failed to include data from one big US medical claim database (TriNetX) 5 and also three national health registries in Scotland, 6 Norway 3 and Denmark. 7 Further, there was no analysis on the incidence of DKA following SARS-CoV-2 infection in both previous meta-analyses. Therefore, we conducted a systematic review and meta-analysis to summarize the current evidence to estimate the risk of developing new-onset type 1 diabetes and DKA in children and adolescents as postacute sequelae of SARS-CoV-2 infection.…”

“…Additionally, Ssentongo and colleagues did not identify all relevant studies in their search strategy. For example, two relevant national health registries for all children and adolescents in Norway 3 and Denmark 7 were missing in their analyses. Importantly, Zhang and colleagues conducted their meta‐analysis based on including only two studies for children and failed to include data from one big US medical claim database (TriNetX) 5 and also three national health registries in Scotland, 6 Norway 3 and Denmark 7 .…”