More Data Needed to Determine COVID-Diabetes Link in KidsJuly 25, 2022
The incidence of diabetes among children was slightly higher during the COVID-19 pandemic, but ultimately not significantly different than expected rates, according to a cross-sectional study from Canada.
Among over 2 million kids, the relative rate of new diabetes presentations was 15% to 32% lower in March to May 2020, and 33% to 50% higher in February to July 2021, though overall there was no significant difference in observed versus expected relative rates (RR 1.09, 95% CI 0.91-1.30), reported Rayzel Shulman, MD, PhD, of the Hospital for Sick Children in Toronto, and colleagues in a research letter published in JAMA Network Open.
Previous data from the CDC showed an association between COVID infection and new-onset diabetes in children, they noted. Moreover, a study from earlier this year reported a 57% increase in cases of new-onset diabetes among kids admitted to a San Diego hospital from March 2020 to March 2021.
Despite these findings, “[t]here is no clear mechanism by which COVID-19 infection might cause new-onset diabetes,” Shulman and team noted.
“The lack of both an observable increase in overall diabetes incidence among children during the 18-month pandemic restrictions and a plausible biological mechanism calls into question an association between COVID-19 and new-onset diabetes,” they concluded. “Given the variability in monthly RRs, additional population-based, longer-term data are needed to examine the direct and indirect effects of COVID-19 and diabetes risk among children.”
Because Canada has one of the highest incident rates of type 1 diabetes worldwide, Shulman and colleagues examined whether diabetes incidence increased during the pandemic among individuals ages 17 and younger in Ontario.
They used health administrative data from January 2017 to September 2021, and included all children eligible for universal healthcare insurance on January 1 of each year studied.
From November 2020 to April 2021, an estimated 3.3% of youth in Ontario had COVID. The authors used generalized estimating equations for Poisson regression to model 3-year pre-COVID rates of new-onset diabetes adjusted for age, sex, pre-COVID month, and secular trend, and then used the models to estimate expected post-COVID monthly rates of new-onset diabetes.
For the 2021 cohort, 2,700,178 kids were included. Mean age was 9.2 years, and 48.7% were girls.
Shulman and team noted that the sample size for this study was small, which was a limitation. Furthermore, they could not differentiate between cases of type 1 and type 2 diabetes, which may have affected results.
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health, as well as a grant from the Canadian Institutes of Health Research.
Shulman reported personal fees from Dexcom and receiving grants from the Canadian Institutes of Health Research. Other co-authors also reported grants from the Canadian Institutes of Health Research.