Mental stress and viral infections are considered potential risk factors for the development of type 1 diabetes in children. Should we, therefore, expect an increase in incidence due to the COVID-19-related lockdown? In Germany, a study has been carried out on this issue which has provided new insights for epidemiological and diabetological experts.1
Following catastrophic events such as the 1986 nuclear accident in Chernobyl or the 1994 earthquake in Los Angeles, an increase in the incidence of type 1 diabetes has been observed. The COVID-19 pandemic, with the social and economic restrictions it entails, could also be such an event. This is particularly true for children and young people who have become socially isolated due to the closure of kindergartens and schools and the restrictions on hobbies and meeting friends. In addition, the occurrence of type 1 diabetes is also associated with viral infections that alter the immune response and can lead to direct damage to β cells.
Sascha René Tittel from the Institute of Epidemiology and Medical Biometry at Ulm University (Germany), together with 216 pediatric diabetes centers in the country, has investigated whether there is a link between the incidence of type 1 diabetes and the COVID-19 lockdown between March and May 2020. To this end, the rate of newly diagnosed cases of type 1 diabetes in children aged six months to 18 years between 13 March and 13 May 2020 was compared with the same period in the years 2011 to 2019.
Overall, it was confirmed that the incidence of type 1 diabetes in children has increased in recent years - from 16.4 per 100,000 in 2011 to 22.4 per 100,000 in 2019, and in spring 2020 the incidence was 23.4/100,000 - based on 532 cases among 13.7 million children under 18. Thus no significant increase compared to previous years was observed. This also applied after stratification by age group or gender. However, a non-significant higher rate was recorded for male children (28.1 compared to the expected 23.1/100,000) - for girls the rate was rather lower than expected at 18.6/100,000 (20.9).
Thus, the incidence of type 1 diabetes in children follows the trend of recent years - a short-term impact of the COVID 19 pandemic is not observed. A strong direct diabetogenic effect thus seems unlikely, but the authors write that weak effects cannot be excluded due to the relatively low COVID-19 rate in Germany. It also remains unclear whether the possible negative effects of increased stress levels offset each other with the increased protection against viral infections through the lockdown.
Source:
1. Sascha René Tittel et al; Did the COVID-19 Lockdown Affect the Incidence of Pediatric Type 1 Diabetes in Germany? Diabetes Care (2020); DOI: https://doi.org/10.2337/dc20-1633