In this propensity score-matched analysis involving more than 500,000 pediatric patients, the risk of newly diagnosed T1D was higher among those previously infected with SARS-CoV-2 than with other respiratory infections at the following time points post-infection:

1 month: HR 1.96 (95% CI 1.26-3.06) 3 months: HR 2.10 (95% CI 1.48-3.00) 6 months: HR 1.83 (95% CI 1.36-2.44)

Similar risks were observed for the SARS-CoV-2 group compared with other control cohorts who had encounters with the health care system at 6 months, such as those who attended child wellness visits (HR 2.10, 95% CI 1.61–2 .73) and those with fractures (HR 2.09, 95% CI 1.41-3.10), Rong Xu, PhD, of Case Western Reserve University School of Medicine in Cleveland, and colleagues reported in a research letter published in JAMA Network Open. In a subgroup analysis that divided the children into two age groups — ages 0 to 9 and ages 10 to 18 — there was a higher risk at 6 months for both groups:

Ages 0–9: HR 1.73 (95% CI 1.02–2.94) Ages 10–18: HR 2.18 (95% CI 1.57–3.03)

“Respiratory infections have previously been associated with the occurrence of T1D, but this risk was even higher among people with COVID-19 in our study, raising concern about long-term, post-COVID-19 autoimmune complications in young people,” they wrote. “The increased risk of new-onset T1D after COVID-19 adds an important consideration to the risk-benefit debates for prevention and treatment of SARS-CoV-2 infection in pediatric populations,” they concluded. During the pandemic, there was an increase in T1D cases among children, Xu’s team noted. The CDC reported that children diagnosed with SARS-CoV-2 were more likely to develop diabetes, but did not distinguish between type 1 and type 2. However, other studies have suggested that more evidence is needed to confirm the link. “Covid-19 can have significant effects on multiple organ systems in children, including the pancreas and the immune system,” Xu told MedPage Today. As for next steps in the research, “first, we would like to follow the cohorts for a longer period of time to see if the increased T1D risk is transient or persistent,” noted Xu. “Second, [we would like to] rapidly assess whether existing drugs (eg, antivirals, anti-inflammatory drugs) can be repurposed to treat T1D associated with COVID-19.” “Third, we need to investigate whether T1D caused by COVID-19 is different from traditional T1D,” he added. “Fourth, we would like to examine whether COVID-19 is also associated with new diagnoses of type 2 diabetes in children.” For this study, Xu and colleagues reviewed electronic health record data from the Global Collaborative Network on 1,091,494 pediatric patients who had COVID-19 (n=314,917) or non-COVID respiratory infections (n=776,577) in 74 centers in 50 US states and 14 countries from March 2020 to December 2021. They matched 285,628 patients from each infection group 1:1 for family history of diabetes and demographics. Patients were further divided into younger and older age groups. The mean age of patients was 9 in both groups after matching. More than half of the patients were white and half were boys. Only 1-2% had a family history of diabetes. At 6 months post-infection, 0.04% of the COVID-19 group received a new diagnosis of T1D compared with 0.03% of the non-COVID-19 group. Xu and colleagues noted the observational, retrospective design of their study, which may have introduced potential bias. In addition, the use of electronic health records increased the risk of diagnostic misclassification.

Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious Diseases. Its headquarters are in Chicago.

Revelations This study was supported by grants from the Cleveland Clinical and Translational Science Collaborative, the National Institute on Aging, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. Xu reported no conflict of interest. One co-author reported funding from the National Institutes of Health.