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Diabetes in children peaks after Covid – Canadian study

Scientists have noted an unusual spike in the number of children and teenagers worldwide diagnosed with type 1 diabetes since Covid.

Based on their recent research – for which they collated data from a number of countries on more than 38 000 young people diagnosed during the pandemic – the authors describe the surge as “substantial”, saying that more work was needed to understand why the numbers were going up, reports BBC News.

While some of the rise could be attributed to catch-up – from backlogs and delays when health services were shut – this does not explain all of the newly diagnosed cases, they added.

Before the pandemic, the incidence rate of childhood type 1 diabetes was already increasing by about 3% a year.

However, this recent study (published in JAMA Network Open) found a noteworthy 14% rise in the rate during the first year of the pandemic, compared with before Covid; and in the second year of Covid, the rate was up about 27% on pre-pandemic levels

The study team, from the University of Toronto, says that regardless of the cause, more resources and support may be needed for the growing number of children and adolescents affected by type 1 diabetes.

What’s behind it?

While it is unclear what is responsible for the surge in cases, there are some theories. One is that Covid can trigger a reaction in some children, which increases the risk of diabetes. But among the studies looking for this type of autoimmune reaction – where the body starts to attack some of its own healthy cells – not all have found evidence to support this theory.

Another hypothesis is that exposure to some germs in childhood can help guard against a number of conditions, including diabetes. Some scientists believe it is possible that lockdowns and physical distancing during Covid meant many children did not get sufficient exposure to germs and missed out on this additional protection.

Hilary Nathan, policy director at type 1 diabetes charity JDRFUK, said: “This research reflects a life-changing reality for so many families in the UK."

She urged people to look out for the symptoms of type 1 diabetes: tiredness, thirst, needing to go to the toilet to urinate more often, and weight loss or increasing thinness – collectively known as the four Ts.

“Knowing these signs and getting an early diagnosis and swift treatment can be life-saving,” she said.

Study details

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Daniel D’Souza,  Jessica Empringham,  Petros Pechlivanoglou, et al.

Published in JAMA Network Open on 30 June 2023

Key Points

Question Was there a change in the incidence of diabetes in children and adolescents after the onset of the COVID-19 pandemic?

Findings In this systematic review and meta-analysis of 42 studies including 102 984 youths, the incidence of type 1 diabetes was higher during the COVID-19 pandemic compared with before the pandemic.

Meaning The findings suggest the need to elucidate possible underlying mechanisms to explain temporal changes and increased resources and support for the growing number of children and adolescents with diabetes.

Abstract

Importance
There are reports of increasing incidence of paediatric diabetes since the onset of the Covid-19 pandemic. Given the limitations of individual studies that examine this association, it is important to synthesise estimates of changes in incidence rates.

Objective
To compare the incidence rates of paediatric diabetes during and before the COVID-19 pandemic.

Data Sources
In this systematic review and meta-analysis, electronic databases, including Medline, Embase, the Cochrane database, Scopus, and Web of Science, and the grey literature were searched between 1 January 2020, and 28 March 2023, using subject headings and text word terms related to COVID-19, diabetes, and diabetic ketoacidosis (DKA).

Study Selection
Studies were independently assessed by 2 reviewers and included if they reported differences in incident diabetes cases during vs before the pandemic in youths younger than 19 years, had a minimum observation period of 12 months during and 12 months before the pandemic, and were published in English.

Data Extraction and Synthesis
From records that underwent full-text review, two reviewers independently abstracted data and assessed the risk of bias. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Eligible studies were included in the meta-analysis and analysed with a common and random-effects analysis. Studies not included in the meta-analysis were summarised descriptively.

Main Outcomes and Measures
The primary outcome was change in the incidence rate of paediatric diabetes during vs before the Covid-19 pandemic. The secondary outcome was change in the incidence rate of DKA among youths with new-onset diabetes during the pandemic.

Results
Forty-two studies including 102 984 incident diabetes cases were included in the systematic review. The meta-analysis of type 1 diabetes incidence rates included 17 studies of 38 149 youths and showed a higher incidence rate during the first year of the pandemic compared with the pre-pandemic period (incidence rate ratio [IRR], 1.14; 95% CI, 1.08-1.21). There was an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the pre-pandemic period (IRR, 1.27; 95% CI, 1.18-1.37). Ten studies (23.8%) reported incident type 2 diabetes cases in both periods. These studies did not report incidence rates, so results were not pooled. Fifteen studies (35.7%) reported DKA incidence and found a higher rate during the pandemic compared with before the pandemic (IRR, 1.26; 95% CI, 1.17-1.36).

Conclusions and Relevance
This study found that incidence rates of type 1 diabetes and DKA at diabetes onset in children and adolescents were higher after the start of the pandemic than before. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.

 

JAMA Network Open article – Incidence of Diabetes in Children and Adolescents During the COVID-19 PandemicA Systematic Review and Meta-Analysis (Creative Commons Licence)

 

BBC article – Covid pandemic linked to surge in child and teen diabetes (Open access)

 

See more from MedicalBrief archives:

 

Possible link between COVID-19 and new-onset type 1 diabetes in children — small UK study

 

Rotavirus vaccine also protects children against type 1 diabetes

 

New screening method to detect future type-1 diabetes risk

 

Worldwide type 1 diabetes cases expected to double by 2040 – Australian study

 

 

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