More COVID-19, More Type 1 Diabetes Cases, But No One Knows Why

The link between the least common form of type 1 diabetes and Covid-19 infection appears to be growing.

A study of more than 38,000 young people confirms what researchers began to suspect: The COVID-19 pandemic is leading to an increase in cases of type 1 diabetes in children and teens. At first, researchers thought the increase was caused by the virus itself, but that may not be the case.

The study, published in JAMA Network Open, pooled data from 17 previous studies and found that in 2020, the first year of the pandemic, rates of type 1 diabetes among children and adolescents younger than 19 were higher than in 2020 Out about 14%. the past year. In the second year of the pandemic, the incidence rate increased even more, a 27% increase over 2019.

The data dovetails with another large study of more than 1 million children presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Stockholm (Sweden).

“The incidence was much higher than we expected,” said lead author Rayzel Shulman of the SickKids Research Institute in Toronto, Canada. Before COVID-19, the incidence of type 1 diabetes in children was increasing at a constant rate of about 2% to 4% per year.

Type 1 diabetes occurs when the body’s own immune system attacks the cells in the pancreas that produce insulin, which regulates blood sugar levels. As a result, blood sugar levels can fluctuate dangerously. In the long run, this can damage people’s blood vessels, which can lead to blindness, kidney failure, heart disease or nerve damage, and in worst cases, amputation.

Virginia Bellido of the Spanish Diabetes Association admits that in Spain there are no concrete figures on how many new cases of type 1 diabetes are being diagnosed as a result of the epidemic.

However, he adds that there are different studies documenting an increase in the incidence of type 1 diabetes cases during the pandemic, and that “many of these cases showed higher rates of ketoacidosis (when the body doesn’t make enough insulin) allow blood sugar to enter cells for energy (possibly due to), The restrictions of the epidemic itself».

Diabetic ketoacidosis, a life-threatening complication of new-onset type 1 diabetes, increased by 26% between 2019 and 2020, likely because people are hesitant or unable to seek emergency care when symptoms first appear. Diabetic ketoacidosis is preventable but can have long-term effects once it occurs, so”This is actually one of the most important findings of this study.Shulman said.

Despite numerous studies trying to find evidence that SARS-CoV-2 triggers increased or severe damage to pancreatic cells, the response has been unsatisfactory.

Bellido explained that it was initially thought that the increased incidence of diabetes was due to the direct impact of the virus on the destruction of pancreatic beta cells. “But it’s not clear today.”

Other factors that could play a role are factors inherent to the pandemic, such as lifestyle changes, changes in pediatric or situational infection patterns, or increased pandemic-related stress. «But so far, the exact cause of the increased incidence is unclear.The endocrinologist at the Santa Maria del Rocio University Hospital (Seville) says

Schulman and his colleagues limited their analysis to studies with at least 12 months of data before and during the pandemic. They also included only those who reported the size of the study population, not just the number of cases.

In addition to demonstrating that childhood type 1 diabetes rates increased during the first two years of the pandemic, they also found that the pandemic changed the seasonality of childhood type 1 diabetes.. The disease often follows a distinct seasonal pattern, with more new cases diagnosed in winter than in summer.

The Seville expert commented that it is true that the incidence is usually higher in winter and that this seems to have increased with the coronavirus pandemic. seasonal lost. reason? “There’s nothing definitive either,” he replied, noting that over the next few years we’ll see if this seasonal pattern is broken.

Type 2 diabetes occurs when the pancreas does not produce enough insulin and the body stops responding to it. Inactivity and obesity are risk factors.

It’s unclear what triggered the sudden rise in diabetes rates and how long the trend might last

Razel Schulman

Institute for Sick Children

The meta-analysis reconfirms that children diagnosed with type 1 diabetes tend to have more severe disease during the pandemic than before.

Schulman acknowledged that it’s unclear what triggered the spike in diabetes and how long the trend might last.

But other researchers aren’t entirely convinced by the findings. Lars Stene, an epidemiologist who studies risk factors for type 1 diabetes at the Norwegian Institute of Public Health in Oslo, says the 14 percent increase in incidence “seems incredible to me” in just one year.

As for the underlying cause, Kamrath, who wrote an invited commentary for the meta-analysis, said it now appears “unlikely” that SARS-CoV-2 directly damaged pancreatic cells in children.

If the parallel epidemic of diabetes isn’t caused by a virus wiping out pancreatic cells, that presents an opportunity for researchers to investigate other factors that may have contributed to the decades-long rise in childhood diabetes, Schulman said.

Thirunavukkarasu noted that the most likely explanation is that the immune system’s attack on the pancreas is “triggered by the COVID-19 infection, as well as other infections such as enteroviruses and hepatitis B.”

We don’t know exactly what is the immediate mechanism linking this viral infection to the development of type 1 diabetes.

Virginia Bellido

Spanish Diabetes Association.

That could be because the pandemic accelerated the rate at which children were already at risk of developing type 1 diabetes, or for unknown reasons, more children developed the autoimmune disease than before the pandemic, Schulman said.

Lockdowns and physical distancing may reduce children’s exposure to respiratory viruses other than Covid-19, inadvertently removing unknown protective effects, the report added.

According to Bellido, the exact etiology of type 1 diabetes is unknown, and both genetic and environmental predisposition factors have been described, and among these environmental factors, in addition to some factors such as diet, are viral infections. However, SED experts believe that “nor there is direct evidence that a specific strain of the virus is the direct cause of type 1 diabetesAlthough different infections have been described as possible triggers of type 1 diabetes, such as SARS-Cov2, we do not know exactly what are the direct mechanisms linking infection with these two viruses to the development of type 1 diabetes. Type 1 diabetes”.

Researchers are exploring other potential triggers, including a diet rich in highly processed foods, weight gain, and changes in microbes in the gut that affect immunity. «There is no single answer to this. “they concluded.

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