Notable Increase in Type 1 Diabetes with the COVID-19 Pandemic

The rise in childhood type 1 diabetes opened new avenues for researchers to explore the cause of the disease.

A study of more than 38,000 young people has confirmed what researchers had begun to suspect: the COVID-19 pandemic precipitated a jump in cases of type 1 diabetes in children and adolescents . At first, researchers thought the spike was caused by the virus itself, but that’s probably not true. However, since the overall cause of type 1 diabetes remains a mystery, the findings offer new mechanisms for researchers to explore.

The study, published in JAMA Network Open , pooled data from 17 previous studies and found that the incidence of type 1 diabetes in children and adolescents under 19 years of age was 14% higher during 2020, the first year of the pandemic, than the last year. The incidence increased even further in the second year of the pandemic, 27% more than in 2019.

"It was a much higher incidence than we expected," says lead author Rayzel Shulman, a pediatric endocrinologist at the SickKids Research Institute in Toronto, Canada. Before COVID-19, the incidence of type 1 diabetes in children was increasing at a steady rate of about 2% to 4% per year.

“Now, suddenly, we see a tenfold increase ,” says Clemens Kamrath, a diabetes researcher at Justus Liebig University in Giessen, Germany. “This is definitely a significant leap, to an extent and at a speed that was not thought possible.”

Incidence of diabetes in children and adolescents during the COVID-19 pandemic. A systematic review and meta-analysis

Summary

Importance  

There are reports of an increasing incidence of pediatric diabetes since the start of the COVID-19 pandemic. Given the limitations of individual studies examining this association, it is important to synthesize estimates of changes in incidence rates.

Aim  

To compare the incidence rates of pediatric diabetes during and before the COVID-19 pandemic.

Data sources  

In this systematic review and meta-analysis, electronic databases, including Medline, Embase, the Cochrane Database, Scopus, and Web of Science, were searched between January 1, 2020 and March 28, 2023, using headings of subject and text word terms related to COVID-19, diabetes and diabetic ketoacidosis (DKA).

Study selection  

Studies were independently assessed by 2 reviewers and included if they reported differences in incident diabetes cases during vs before the pandemic in young people under 19 years of age, had a minimum observation period of 12 months during and 12 months before the pandemic. pandemic, and were published in English.

Data extraction and synthesis  

Of records that underwent full-text review, 2 reviewers independently abstracted data and assessed risk of bias. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed . Eligible studies were included in the meta-analysis and analyzed with a common and random-effects analysis. Studies not included in the meta-analysis were summarized descriptively.

Main results and measures  

The primary outcome was the change in the incidence rate of pediatric diabetes during vs before the COVID-19 pandemic. The secondary outcome was the change in the incidence rate of diabetic ketoacidosis (DKA) among youth with new-onset diabetes during the pandemic.

Results  

Forty-two studies including 102,984 incident cases of diabetes were included in the systematic review.

The meta-analysis of type 1 diabetes incidence rates included 17 studies of 38,149 young people and showed a higher incidence rate during the first year of the pandemic compared to the pre-pandemic period (incidence rate ratio [IRR], 1.14; 95% CI, 1.08-1.21).

There was a higher incidence of diabetes during months 13 to 24 of the pandemic compared with the pre-pandemic period (IRR, 1.27; 95% CI, 1.18-1.37).

Ten studies (23.8%) reported incident cases of type 2 diabetes in both periods. These studies did not report incidence rates, so the results were not pooled. Fifteen studies (35.7%) reported the incidence of diabetic ketoacidosis (DKA) and found a higher rate during the pandemic compared to before the pandemic (IRR, 1.26; 95% CI, 1.17-1 ,36).

Conclusions and relevance  

This study found that the incidence rates of type 1 diabetes and diabetic ketoacidosis (DKA) at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic.

More resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to evaluate whether this trend persists and may help elucidate possible underlying mechanisms to explain the temporal changes.

Transcendence

The results of our systematic review and meta-analysis demonstrated an increased incidence of childhood diabetes after the onset of the COVID-19 pandemic. The higher incidence rate of type 1 diabetes appeared to persist beyond the first year of the pandemic; This has important implications given the limited staff resources in pediatric diabetes care to provide initial diabetes education at diagnosis and for long-term care. Future studies examining longer-term trends in the incidence of type 1 and 2 diabetes may evaluate whether the increased incidence rate of type 1 diabetes continued and whether there was an increased incidence rate of pediatric type 2 diabetes.

The increasing prevalence of diabetic ketoacidosis (DKA) at the time of diabetes diagnosis brings to light the need to identify gaps in the pathway from the time children develop signs of diabetes to the subsequent diagnosis of DKA. This knowledge is necessary to inform the development and implementation of effective strategies to prevent diabetic ketoacidosis (DKA) at the time of diagnosis in children. These may include awareness campaigns targeting the public and healthcare professionals and addressing hesitancy to seek emergency care.