The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry

Abstract

OBJECTIVE To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. RESEARCH DESIGN AND METHODS We analyzed data on 17,280 cases of T1D diagnosed during 2018–2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. RESULTS The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1–12.2) in 2018 to 21.7 (20.6–22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2–14.0) in 2018 to 26.7 (25.7–27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5–12.9) to 24.7 (24.0–25.5) for adolescents ages 12–18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018–2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. CONCLUSIONS The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.

Incidence of new-onset type 1 diabetes during Covid-19 pandemic: A French nationwide population-based study

“…We found, for the first time in a nationwide population-based study, a lack of increased incidence of new-onset T1DM during the Covid-19 pandemic. Our results are in line with a recent study, from a worldwide registry, showing no significant increase in pediatric new-onset T1DM in 2020 and 2021 [7] . Our results are consistent with two large cohort studies, reporting no evidence of direct link between infection with SARS-CoV-2 and the development of new-onset T1DM 1D [ 6 , 10 ].…”

“…Nevertheless, this study brought no evidence of a direct effect of the Covid-19 pandemic on this increasing incidence. In a study conducted in 92 sites worldwide, no increase in pediatric new-onset T1DM was observed during the Covid-19 pandemic [7] .…”

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

“…Forty-two records met the full inclusion criteria. 3,13,23,24, The manual search of the included studies' reference lists did not yield additional studies.…”

Multiple influences of the COVID-19 pandemic on children with diabetes: Changes in epidemiology, metabolic control and medical care

“…Like the DPV studies, they concluded that the SARS-CoV-2 infection itself was not the cause of this increase. A more conclusive result was reached by the Sweet consortium[ 29 ], which analyzed data from 17280 cases of T1D diagnosed between 2018 and 2021 from 92 worldwide centers and focused on seasonality. They failed to prove strong direct virus-related effects, and only described a change in seasonality reflecting the spread of the pandemic: A delay in the usual winter peak in Northern Europe and North America, in fact, and a stronger peak during the summer and autumn months were described.…”