Is Type 1 Diabetes a Post-Acute Sequela of COVID-19?

Citation: Trehan, T., Bajaj, N., Talanki, A., Sathish, T. (2023). Is Type 1 Diabetes a Post-Acute Sequela of COVID-19. Ope Acce Jou Dis Glo Heal, 1(2), 57-58.

Abstract

Type 1 diabetes is a global health problem [1], as is the corona- virus disease 2019 (COVID-19) [2]. Whether new-onset type 1 diabetes is a consequence of COVID-19 has been a subject of considerable debate within the medical community [2, 3]. In a recent meta-analysis, epidemiological data from seven cohorts across six studies involving over 11 million children and adoles- cents were synthesized [4]. The analysis showed that the risk of developing type 1 diabetes was 42% higher among long-COVID patients than those without COVID-19 (risk ratio: 1.42, 95% CI 1.13, 1.77) [4]. Notably, most cohorts (5 out of 7) showed a pos- itive association. The risk ratios from all four U.S. cohorts and the Norway cohort were significant and greater than one, while those from the Scotland and Denmark cohorts were less than one and non-significant. Variations in study results could be attribut- ed to differences in children’s ages, genetic susceptibility, and vaccination status, specific pandemic periods studied, duration of follow-up, confounding variables adjusted for in regression models, and rates of severe acute respiratory syndrome corona- virus 2 (SARS-CoV-2) testing.

Keywords

COVID-19, Type 1 Diabetes, long-COVID, Diabetes, Incidence.

Type 1 diabetes is a global health problem [1], as is the corona- virus disease 2019 (COVID-19) [2]. Whether new-onset type 1 diabetes is a consequence of COVID-19 has been a subject of considerable debate within the medical community [2, 3]. In a recent meta-analysis, epidemiological data from seven cohorts across six studies involving over 11 million children and adoles- cents were synthesized [4]. The analysis showed that the risk of developing type 1 diabetes was 42% higher among long-COVID patients than those without COVID-19 (risk ratio: 1.42, 95% CI 1.13, 1.77) [4]. Notably, most cohorts (5 out of 7) showed a pos- itive association. The risk ratios from all four U.S. cohorts and the Norway cohort were significant and greater than one, while those from the Scotland and Denmark cohorts were less than one and non-significant. Variations in study results could be attribut- ed to differences in children’s ages, genetic susceptibility, and vaccination status, specific pandemic periods studied, duration of follow-up, confounding variables adjusted for in regression models, and rates of severe acute respiratory syndrome corona- virus 2 (SARS-CoV-2) testing.

Insights into the presence of islet autoantibodies in children in- fected with SARS-CoV-2 were obtained from the TEDDY (The Environmental Determinants of Diabetes in the Young) and GPPAD (Global Platform for the Prevention of Autoimmune Diabetes) studies [5, 6]. In the TEDDY study, 4,586 children (aged 9 to 15 years) in the U.S., Sweden, Finland, and Germany were followed from January 2020 to December 2021. Among them, 18.6% of those with islet autoantibodies tested positive for SARS-CoV-2 antibodies, compared to 15.4% without islet autoantibodies over two years [5]. More compelling evidence emerged from the GPPAD study, which followed 1,050 infants (aged 4 to 7 months) from April 2018 through June 2022 across Germany, Poland, Sweden, Belgium, and the UK. In this study, children with SARS-CoV-2 antibodies had a significantly higher incidence rate of islet autoantibodies than those without SARS- CoV-2 antibodies (7.8 per 100 person-years vs. 3.5 per 100 per- son-years), with a hazard ratio of 3.5 (95% CI, 1.6, 7.7; p=0.002) [6]. Notably, one-third (33.3%) of children with islet autoanti- bodies developed type 1 diabetes.

Collectively, data from the recent meta-analysis of epidemiolog- ical data and mechanistic studies provide strong evidence that new-onset diabetes is a post-acute sequela of COVID-19 [3, 7, 8]. This underscores the importance of conducting research on the long-term health consequences of COVID-19, especially new-onset type 1 diabetes to better inform clinical care [3, 7].