Since almost the start of the COVID-19 pandemic, it’s been known or suspected that people with diabetes are at greater risk for poor outcomes if they develop the infection. We’ve learned more, though, about specific risks as researchers have studied data from the past few months. As we’ve reported here at Diabetes Self-Management, we now know that people with both type 1 and type 2 diabetes are at greater risk for poor outcomes, including death, if they’re hospitalized for COVID-19.
But until recently, we didn’t know much about what effect, if any, COVID-19 has on new cases of type 1 diabetes. A new study marks a step toward understanding that connection.
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Type 1 cases rise at some locations
Published in the journal Diabetes Care, the study looked at new cases of type 1 diabetes at five different healthcare locations in North West London, England. These inpatient locations — located in hospitals — comprise the area’s Pediatric Diabetes Network, focusing on care for children and teenagers up to 16 years old.
The study looked at the period between March 23 and June 4, 2020, when the COVID-19 pandemic was at its height in the region. Overall, during this period, 30 children between the ages of 23 months and 16.8 years developed type 1 diabetes within the network. Out of the five locations, two experienced a higher number of new cases than is typical during April and May — 10 new cases each, compared with an average of 2 cases at one location and 4 cases at the other during the previous 5 years.
In the children who developed type 1 diabetes, the clinical picture was concerning. Out of the 30 children, 21 developed diabetic ketoacidosis (DKA), a severe complication of high blood glucose. More than half of these cases, 11, were considered severe. Clinical shock (a sudden, severe lack of blood flow) was present in 12 children when they were admitted, and four had to be treated in pediatric intensive care.
Reasons for increase in type 1 unclear
While the increase in type 1 speaks for itself, it’s not immediately clear why this happened at the two healthcare locations. Tests for the COVID-19 virus were performed on 21 of the children who were admitted and diagnosed with type 1 diabetes. Out of these, only 2 tested positive.
However, antibody tests for the virus — indicating prior exposure to the virus, and possibly a prior infection — were also performed at two of the locations. Out of the 16 children tested for antibodies, three tested positive. This result suggests that more children may have had prior exposure to the virus than just the two with a current infection.
The researchers estimated that overall, the data suggest an 80% increase in new cases of type 1 diabetes during the study period, compared with a typical year. This study did not demonstrate a direct link to a similar increase in COVID-19 or exposure to the virus. However, previous studies have shown that the virus may enter pancreatic islet cells, leading to or increasing beta cell damage and potentially contributing to the onset of type 1 diabetes.
The researchers note that there are other, similar reports from other countries — China and Italy — showing an increase in new type 1 diabetes during the pandemic, but apparently unrelated to infection with the virus. Some of these reports also suggest small, localized increases in type 1, as the current study found to be the case with only two of its five locations seeing an increase.
Further studies are needed, the researchers emphasize, to establish a clear link between the virus and type 1 or a more severe presentation of new-onset type 1 that requires hospitalization or intensive care.