COVID-19 appears to increase the risk of new diagnosis of type 1 diabetes in children
When a child with new onset of type 1 diabetes appears in our health care network they are referred to the PICU for initial management. This is because they typically are extremely ill with what is called diabetic ketoacidosis, in which acid and other toxic materials caused by lack of insulin accumulate in the blood stream. Type 1 diabetes is the most common of what we term autoimmune diseases, in which the body’s immune system attacks itself. In this case, the autoantibodies attack the cells in the pancreas that make insulin and destroy them. We don’t know what causes this process, but most experts think it begins with a viral infection, after which the immune system, activated by the infection, turns rogue and attacks the insulin-producing cells. The propensity to do this is likely determined by a genetic predisposition.
Many of us have had the feeling we are seeing a spike in new cases of type 1 diabetes in children, and have wondered if the COVID-19 epidemic has anything to do with this increase. After all, an epidemic of a viral infection might be expected to increase the risk in genetically susceptible children. A recent study from the CDC’s respected Morbidity and Mortality Weekly Report gives us some new information about this. The authors looked at new cases of type 1 diabetes in children for the several years prior to the COVID epidemic to establish a baseline. They then evaluated new cases during the COVID epidemic and looked for differences between children who had COVID and those who didn’t. In a nutshell, the study documents an increased risk of type 1 diabetes in children following COVID-19 infection. Persons aged <18 years with COVID-19 were more likely to receive a new diabetes diagnosis >30 days after infection than were those without COVID-19. They also evaluated in parallel the effects of non-COVID respiratory infections; non-COVID-19 respiratory infection was not associated with an increased risk for diabetes. What was the size of this effect? The hazard ratio for developing type 1 diabetes in children with a documented COVID infection was quite significant for these sorts of studies — 2.66. This is not an isolated study. For example, a study from the UK estimated an 80% increase in their region of new cases of type 1 diabetes in children owing to COVID-19.
These are preliminary data and I’m further studies will follow. But this is yet another reason to vaccinate your children for COVID-19.