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COVID-19 may accelerate progression of presymptomatic type 1 diabetes in youth, a German study suggested.

Incidence of clinical type 1 diabetes nearly doubled after the pandemic started among 591 youth ages 1 to 16 known to have presymptomatic type 1 diabetes, Anette-Gabriele Ziegler, MD, of the Institute of Diabetes Research at Helmholtz Munich in Neuherberg, Germany, and colleagues wrote in a .

During the prepandemic period, the incidence rate for clinical type 1 diabetes development was 6.4 (95% CI 4.9-8.2) per 100 person-years, compared with 12.1 (95% CI 10.1-14.4) in the pandemic period (P<0.001).

"A key question was whether this increase was predominantly in those children who had been infected," Ziegler told 乌鸦传媒. "The answer was yes."

Of the 353 kids that had COVID infection information, the incidence rate was 8.6 per 100 person-years (95% CI 6.2-11.7) for participants testing negative for COVID-19. This wasn't significantly different compared with the prepandemic period (P=0.16).

But after COVID-19 infection, the incidence rate jumped to 14.0 per 100 person-years (95% CI 9.9-19.2). This was significantly higher than when they tested negative and also compared with the prepandemic period (P=0.04 vs pandemic COVID-19 negative; P<0.001 vs prepandemic period).

"We know that the virus can infect the pancreatic islets so it could be causing damage or change in the beta cells that make insulin," said Ziegler when discussing possible mechanisms behind this association. "Second, there is generalized inflammation during the infection and there may be a stimulation of the immune response. Third, there could be metabolic stress from the infection that affects the beta cells that make insulin.

"We had been screening and following children in an early presymptomatic stage of type 1 diabetes for several years. We noticed an increase in the numbers of children who progressed to clinical disease," said Ziegler. But she wasn't entirely surprised by these findings, as several other reports indicated a spike in type 1 diabetes prevalence during the pandemic. "The thought that COVID-19 could affect disease initiation and progression has been in the wind for a while," she noted.

To dive into this topic, youth were identified in the German Fr1da-screening program from 2015 to 2023. All patients had presymptomatic diabetes defined as persistent, confirmed positive results for two or more islet autoantibodies. Their progression was monitored at 3- to 6-month intervals. Clinical type 1 diabetes was defined according to .

COVID infection was either self-reported via the family or identified with SARS-CoV-2 antibodies were confirmed in blood samples collected at study visits.

Vaccination against COVID-19 may be one way to protect presymptomatic type 1 diabetes youth from progression, Ziegler added. She said her group is currently testing whether COVID-19 vaccination can reduce new-onset, presymptomatic type 1 diabetes in of children with genetic risk factors for the condition.

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