Is there a link between COVID-19 and type 1 diabetes in children? | Coronavirus

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Is there a link between COVID-19 and type 1 diabetes in children? | Coronavirus

Around the world, researchers have observed an increase in cases of type 1 diabetes in children since the start of the pandemic. Could COVID-19 have amplified the problem? Three recent studies attempt to clarify this hypothesis.

A child checks his blood sugar.

Previously called childhood diabetes, type 1 diabetes (T1D) is usually diagnosed in children and occurs when the pancreas fails to produce a hormone called insulin. The body uses insulin to allow sugar to enter cells and produce energy.

According to Mélanie Henderson, pediatric endocrinologist, epidemiologist and researcher at CHU Sainte-Justine, several studies before the pandemic already suggested that certain viruses would be a trigger for the disease.

“The notion that a virus can put evidence of type 1 diabetes in predisposed people is not new. »

— Dr. Mélanie Henderson, CHU Sainte-Justine

The virus itself is not the cause of diabetes, says Dr. Rayzel Shulman, an endocrinologist at the Toronto Hospital for Sick Children. The child was already on the path to developing type 1 diabetes and the disease tipped the balance.

The impact of COVID-19 is on the radar of many researchers, as studies show that SARS-CoV-2 can infect and attack the pancreas, which can cause diabetes in people who are predisposed to it.

First, in a study published this week in JAMA Network Open, American researchers analyzed the records of health of 571,256 patients aged 0-18 who were diagnosed with COVID-19 or other respiratory infections between March 2020 and December 2021.

Among the children who were infected, 123 (0.04%) received a new diagnosis of T1D, compared to 72 (0.03%) in children without a diagnosis of COVID-19. This represents a 72% increase in new diagnoses.

Furthermore, in another study, presented at the annual meeting of the European Association for diabetes study, researchers analyzed the national health records of 1.2 million Norwegian children between March 1, 2020 and March 1, 2022.

Of the 424,354 children who tested positive for COVID-19, 990 were diagnosed with T1D. Thus 0.13% of children and adolescents were diagnosed with T1D one month or more after infection with COVID-19, compared to 0.08% in uninfected children. This is a 62% increase in relative risk.

The absolute risk of developing type 1 diabetes […] remains low, said lead author Hanne Løvdal Gulseth, a diabetes expert at the Norwegian Institute of Public Health, in a press release. The vast majority of young people who contract COVID-19 will not develop type 1 diabetes, but it is important for clinicians and parents to be aware of the signs and symptoms.

Finally, according to a study published this summer in Diabetes Care, the risk of developing type 1 diabetes after being infected with COVID -19 is higher, but only for a short time.

According to the Scottish team's analysis, among 1.8 million people under the age of 35, more than 365,000 were infected with COVID-19 between March 2020 and November 2021; 1074 of them were diagnosed with T1D. The researchers estimate that the risk of being diagnosed with T1D was twice as high in infected patients, but that this increased risk only lasted for a month.

While the data from these three new studies add to the body of knowledge, they do not allow firm conclusions to be drawn, say Dr. Henderson and Dr. Shulman.

Dr. Henderson points out, among other things, that the US analysis is an observational study, which cannot establish with certainty whether COVID-19 is indeed the cause.

She points out that the development of type 1 diabetes occurs over months or even years. Young people who developed type 1 diabetes a month after COVID-19, it is clear that the process had already started before. COVID-19 was possibly a trigger, but not necessarily the cause.

Dr. used are sometimes incomplete. For example, there may have been children in the non-COVID group who were infected, but were not tested.

In addition, all three studies analyzed infections before the arrival of the Omicron variant. Since then, millions of Canadian children have been infected. If COVID-19 is a cause, we'd be dealing with a tsunami of diabetes right now, says Dr. Henderson.

She adds that the fact that SARS-CoV-2 has taken over other viruses since the beginning of the pandemic could partly explain why we are seeing an increase in new diagnoses in children infected with COVID-19.

Finally, she recalls that the incidence of diabetes in children had been increasing for several years before the pandemic. The exact causes are more or less clear.

Given reports of increased incidence of diabetes in children during COVID-19, it is important to consider, if these persist, what could be the underlying mechanism. I don't think we have a clear answer yet, adds Dr. Shulman.

This is why Dr. Henderson and Dr. Shulman believe that further studies are needed to better understand this increase in diabetes diagnoses in children, and whether COVID-19 is really to blame. Moreover, Dr. Shulman's team is in the process of completing a review of the scientific literature on this subject and should better understand the impact of the Omicron variant on the risks of a diagnosis of type 1 diabetes as a result of an infection.

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