COVID-19 infection has been associated with a rapid progression to clinical type 1 diabetes in young individuals with presymptomatic disease, according to a recent study by German researchers. Healthcare professionals and researchers have noted an increase in type 1 diabetes diagnoses during the pandemic, although some of this rise may be attributed to healthcare disruptions and delayed diagnoses. However, it remained unclear whether Covid-19 infection itself could hasten the disease’s progression in children with existing islet autoimmunity.
The study utilised data from Germany’s FrIda screening programme, which identified 591 children aged 1 to 16 years with presymptomatic type 1 diabetes between February 2015 and October 2023. These children, all confirmed positive for two or more islet autoantibodies, participated in follow-up programmes to monitor disease progression at intervals of three to six months. Parents reported any Covid-19 infections, and SARS-CoV-2 antibodies were checked during study visits.
Of the 508 children included in the analysis, 358 were followed up before the pandemic (up to 1 March 2020) and 396 during the pandemic (from March 2020 onward). During the pre-pandemic period, 57 participants developed type 1 diabetes, compared to 113 during the pandemic. Among the 396 participants followed during the pandemic, 353 had Covid-19 infection information, and 236 had confirmed SARS-CoV-2 infections.
The incidence rate of clinical type 1 diabetes was 6.4 per 100 person-years before the pandemic, which rose to 12.1 per 100 person-years during the pandemic. Specifically, the incidence rate was 8.6 per 100 person-years among those who tested negative for Covid-19 and 14.0 per 100 person-years among those who tested positive.
The study authors from the Institute of Diabetes Research in Munich suggested that their findings align with previous reports indicating that viral infections, such as enterovirus, could accelerate the progression of presymptomatic type 1 diabetes. They also acknowledged study limitations, including missing Covid-19 data for 42 participants and a lack of information on the severity of Covid-19 cases.
Further studies are required to investigate whether Covid-19 similarly accelerates type 1 diabetes progression in adults and whether vaccination and monitoring for Covid-19 symptoms should be considered for individuals with presymptomatic type 1 diabetes.
Laith Gergi, EMJ
Reference
Friedl N et al. Progression from presymptomatic to clinical type 1 diabetes after covid-19 infection. JAMA. 2024;DOIi:10.1001/jama.2024.11174.
