The study, conducted by the Norwegian Institute of Public Health (NIPH) in Oslo, Norway, used national health registers to examine new-onset type 1 diabetes diagnoses in all youngsters under 18 in Norway (more than 1.2 million individuals) over the course of two years.
It has long been suspected that type 1 diabetes, which is usually diagnosed in younger people and is associated with the failure of the pancreas to produce insulin, is a result of an overresponsive immune reaction, possibly due to a viral infection, including respiratory viruses.
Though several case reports have suggested a link between new-onset type 1 diabetes and SARS-CoV-2 infection in adults, limited evidence exists for children, the researchers said.
The Norwegian Emergency Preparedness Register for COVID-19 is updated daily, providing individual-level data on PCR-confirmed SARS-CoV-2 infections, COVID-19 vaccinations, and disease diagnoses from primary and secondary health care services.
In the study, investigators observed children from March 1, 2020, until they were diagnosed with type 1 diabetes, turned 18, died, or reached the end date of March 22, 2022.
Over the two-year period, the group identified 424,354 children who tested positive for SARS-CoV-2 infection and 990 cases of type 1 diabetes diagnosis among the 1.2 million children and adolescents included in the study.
Adjusting for age, sex, country of origin, geographical area, and socioeconomic factors, the team found that young people who contracted COVID-19 were 60% more likely to develop type 1 diabetes 30 days or more after infection when compared to those without a registered infection or who had tested negative for COVID-19.
"Our nationwide study suggests a possible association between COVID-19 and new-onset type 1 diabetes," Dr. Hanne Løvdal Gulseth, lead author and research director at NIPH, said in a statement.
Gulset noted that the increase could be because of delays in seeking care due to the pandemic, but additionally "several studies have shown that SARS-CoV-2 can attack the beta cells in the pancreas that produce insulin, which could lead to development of type 1 diabetes. It's also possible that inflammation caused by the virus may lead to exacerbation of already existing autoimmunity."
Despite these findings, Gulset indicated that the absolute risk of developing type 1 diabetes was low, increasing from 0.08% to 0.13%. "The vast majority of young people who get COVID-19 will not go on to develop type 1 diabetes, but it is important that clinicians and parents are aware of the signs of symptoms of type 1 diabetes," she said.
The team also noted that their study was observational and does not prove cause and effect. Only children who took a PCR test, not a lateral flow test, and had symptomatic infections were included, which may limit the study's conclusions. Furthermore, there was no significant association between vaccination and type 1 diabetes, the researchers said in a presentation.
Future studies could include long-term follow-up as well as an additional focus on SARS-CoV-2 virus variants to determine the reason for the increased risk for type 1 diabetes, the researchers said.
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