A study published in JAMA has found an association between COVID-19 infection and accelerated progression from presymptomatic to clinical type 1 diabetes in children with preexisting islet autoimmunity. The study, conducted by researchers at the Institute of Diabetes Research, Helmholtz Munich, Germany, followed 509 children aged 1 to 16 years with presymptomatic type 1 diabetes from February 2015 to October 2023.
The incidence rate for the development of clinical type 1 diabetes was significantly higher during the COVID-19 pandemic period (March 1, 2020, to October 2023) at 12.1 per 100 person-years (95% confidence interval [CI], 10.1-14.4) compared to 6.4 per 100 person-years (95% CI, 4.9-8.2) in the prepandemic period (February 2015 to February 2020) (P < .001). The incidence rate ratio was 1.9 (95% CI, 1.4-2.6; P < .001).
Among the 353 participants with COVID-19 infection information during the pandemic period, the incidence rate of type 1 diabetes was 8.6 per 100 person-years (95% CI, 6.2-11.7) while participants had tested negative for COVID-19 (P = .16 vs prepandemic period) and 14.0 per 100 person-years after COVID-19 infection (95% CI, 9.9-19.2, P = .04 vs pandemic COVID-19 negative; P < .001 vs prepandemic period).
The study's findings indicate an association between the COVID-19 pandemic and accelerated progression to clinical type 1 diabetes in youth with presymptomatic disease, particularly among those with COVID-19 infection. The results are consistent with previously reported acceleration of progression in children with presymptomatic type 1 diabetes due to viral infection.
The study's limitations include missing information on COVID-19 infection in 42 participants prior to their development of diabetes, and no data on the severity of COVID-19 infections. Further studies are needed to determine whether COVID-19 also accelerates progression to type 1 diabetes in adults, as well as whether vaccination and monitoring for COVID-19 symptoms should be considered for individuals with presymptomatic type 1 diabetes.
The authors declared having no competing interests.
