A new study in the New England Journal of Medicine found no significant difference in the number of children who received a T1D diagnosis between those with and without a SARS-CoV-2 infection.
A study published in the New England Journal of Medicine did not show that COVID-19 precipitated type 1 diabetes (T1D) in children aged 9 to 15 years, according to the study authors.1
Since increased incidence of pediatric T1D during the COVID-19 pandemic had been widely reported, investigators conducted a prospective, multinational cohort including children aged 9 to 15 years from the United States, Finland, Germany, and Sweden. A total of 4586 children were included and followed from January 2020 through December 2021, representing pre-pandemic and pandemic timeframes, respectively. In the study period, children were tested for T1D every 3 months if they had islet autoantibodies (440). If children did not have islet autoantibodies (4146), they were tested every 6 months. At each follow-up visit, the study participants were tested for SARS-CoV-2 infection and spike (vaccination) antibodies.
In all, 705 children (15.4%) had a positive test result for SARS-CoV-2 infection antibodies. Of these positive results, 623 were from the 4146 children without islet autoantibodies (15.0%, [95% confidence interval [CI], 13.9-16.1]) and 82 were from the 440 children with islet autoantibodies (18.6% [95% CI, 15.0-22.3]).
Confirmed positivity for islet autoantibodies occurred in 40 of the 4146 children without islet autoantibodies, seroconversion to persistent (1.0% [95% CI, 0.7-1.3]). Of these 40 children, 5 had nucleocapsid (infection) antibodies that appeared after seroconversion, while the other 35 children “never had a positive test for nucleocapsid antibodies,” the study authors noted. “Hence, seroconversion did not occur in any children without islet autoantibodies who had had a SARS-CoV-2 infection (0 of 623 children.” In all, seroconversion occurred only in children without islet autoantibodies, who did not have SARS-CoV-2 infection, resulting in 40 of 3523 children (1.1% [95% CI, 0.8-1.5]).
In the 24-month follow-up, 45 children received a T1D diagnosis. Five received a diagnosis before a positive SARS-CoV-2 nucleocapsid antibodies test, 1 received the diagnosis after the detection of SARS-CoV-2 infection, and the other 39 children with T1D, “never had a positive test for nucleocapsid antibodies.” Of these 39 children, 30 were not vaccinated, 4 were vaccinated after the diagnosis, 2 were vaccinated before diagnosis, and 3 were not tested. Depending on islet-autoantibody status, all children were seen wither 4 or 8 times over the study period.
According to the study authors, no evidence demonstrated that the number of children in which, “seroconversion to persistent islet-autoantibody positivity occurred was greater among those with SARS-CoV-2 infection, even with the inclusion of samples obtained after the study period if the last sample within the study period was positive for Covid-19 or islet autoantibodies.” The number of children who received a T1D diagnosis did not differ from children with and children without SARS-CoV-2 infection. Overall, through a prospective, multinational cohort study, investigators determined that COVID-19 did not precipitate T1D.
Authors note findings, “must be tempered somewhat,” because of the limited age range of the children with an increased genetic risk of T1D, and that longer follow-up periods could lead to additional insights.