More kids were diagnosed as having type 1 diabetes after the COVID-19 pandemic began, and researchers have yet to determine the mechanism behind this increased incidence rate, the authors of a new meta-analysis said in JAMA Network Open today.
"Our findings underscore the need to dedicate resources to supporting an acute increased need for pediatric and ultimately young adult diabetes care," the authors said.
Our findings underscore the need to dedicate resources to supporting an acute increased need for pediatric and ultimately young adult diabetes care.
The review included 42 studies involving 102,984 youths, with studies published between January 2020 and March 2023. Studies needed to include least 12 months of observation in both the pandemic and the prepandemic periods to account for the prepandemic seasonality of diabetes incidence and changes in seasonality during the pandemic that differed between Europe and North America, the authors said.
The primary outcome was a change in the incidence rate of pediatric diabetes before and during the COVID-19 pandemic, and a second outcome was the incidence rate of DKA (diabetic ketoacidosis) among youths with new-onset diabetes during the pandemic.
Diabetes incident rates increased in year 2 of pandemic
Overall, 75% of studies included for review showed an increase in the number of incident cases of type 1 diabetes during the first 12 months of the pandemic compared with the 12 months before the pandemic.
The authors found a higher incidence rate during the first year of the pandemic compared with the prepandemic period (incidence rate ratio [IRR], 1.14; 95% confidence interval [CI], 1.08 to 1.21). There was also an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the prepandemic period (IRR, 1.27; 95% CI, 1.18 to 1.37). That is a 16%, and 28% increased incidence rate, respectively.
The unadjusted pooled IRR comparing the first year of the pandemic with the prepandemic period was 1.13 (95% CI, 1.11 to 1.16). Fifteen studies also reported DKA incidence and found a higher rate during the pandemic compared with before the pandemic (IRR, 1.26; 95% CI, 1.17 to 1.36).
"The magnitude of increase in the incidence rate of type 1 diabetes that we observed after the onset of the pandemic was greater than the expected 3% to 4% annual increase in the incidence rate based on prepandemic temporal trends in Europe," the authors said.
No clear mechanism
While other studies have showed increases in pediatric type 2 diabetes diagnoses during the pandemic were likely linked to more sedentary lifestyles, and school and activity closures, there is no clear mechanism by which to explain how SARS-CoV-2 infections contribute to type 1 diabetes.
The authors said one potential explanation is that SARS-CoV-2 infection may contribute to dysregulation of glucose metabolism, and children susceptible to diabetes could be vulnerable to developing the disease following SARS-CoV-2 infection.
The lockdowns put in place during the pandemic also seemed to disrupt the seasonality of diabetes diagnoses. Moreover, the authors said, clinic shutdowns in the early months of the pandemic may have contributed to a rise in DKA cases.
"Individuals living in areas with high COVID-19 positivity reported more hesitancy to seek emergency care for children," the authors wrote. "Therefore, hesitancy to seek care may be an important factor in the observed increased risk of DKA during the pandemic."
Hesitancy to seek care may be an important factor in the observed increased risk of [diabetic ketoacidosis] during the pandemic.
But the increased incidence of DKA in the second year of the pandemic could not be explained by clinic shutdowns or lack of care, said authors of a commentary on the study.
“It is unclear why the increased prevalence of DKA persisted throughout the second year of the pandemic, even though the lockdown in most countries had ended, normal life had indeed resumed, and the vast majority of people had become accustomed to living with a pandemic," they wrote. "Again, the pandemic could accelerate—and possibly unravel—a long-term development in the pathophysiology of type 1 diabetes."