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SARS-CoV-2 and Type 1 Diabetes in Finnish Children
50 Pages Posted: 4 Oct 2022
More...Abstract
Background: The incidence of type 1 diabetes has been reported to have increased during the COVID-19 pandemic, although some studies disagree. The mechanism(s) behind such an increase has remained open.
Methods: We set out to (i) assess the rate of type 1 diabetes during the first 18 months of the COVID-19 pandemic (March 1, 2020 to August 31, 2021, N=785) in Finnish children under the age of 15 years compared to a reference period including three corresponding preceding periods (N=2096) based on the Finnish Pediatric Diabetes Register (FPDR) , (ii) compare the phenotype and HLA genotype of the disease between these two cohorts, and (iii) analyse the proportion of newly diagnosed patients testing positive for SARS-CoV-2 antibodies.
Results: The incidence of type 1 diabetes was 61‧0 (95% CI 56‧8- 65‧4/100,000 person years [PY]) among children under the age of 15 years during the pandemic, which was significantly higher than during the reference period (52‧3; 95% CI 50‧1 to 54‧6/100,000 PY). The incidence rate ratio adjusted for age and sex for the COVID-19 pandemic was 1‧16 (95% CI 1‧06-1‧25) when compared to the reference period. The index cases diagnosed during the COVID-19 pandemic experienced more often diabetic ketoacidosis (p<0‧001), had a higher HbA1c (p<0‧001) and tested more frequently positive for GAD antibodies at diagnosis (p<0‧001). Only five of those diagnosed during the pandemic (0‧9%) tested positive for infection-induced SARS-CoV-2 antibodies.
Interpretation: The observed increase in type 1 diabetes incidence during the first 18 months of the pandemic can hardly be attributed to a direct effect of SARS-CoV-2 but may rather be a consequence of the lockdown of society and social distancing. Those diagnosed with type 1 diabetes during the pandemic had a more severe disease at diagnosis.
Funding Information: Helsinki University Hospital Research Funds, EU H2020 (VEO project), Academy of Finland, Sigrid Jusélius Foundation, Jane & Aatos Erkko Foundation and Medicinska understödsföreningen Liv och Hälsa.
Declaration of Interests: We declare no competing interests.
Ethics Approval Statement: The study protocol of FPDR was approved by the Ethics Committee of the Hospital District of Helsinki and Uusimaa, Helsinki, Finland. All newly diagnosed children with parental consent to participate. 9 Children 10 years of age or older are also asked for informed consent.
Keywords: type 1 diabetes, SARS-CoV-2, COVID-19 pandemic, incidence, diabetic ketoacidosis
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