Journal of Pediatric Perspectives

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Indexing and Abstracting

Related Links

FAQ

Peer Review Process

News

Incidence of Type 1 Diabetes Before and During the COVID-19 Pandemic in Isfahan, Iran

Document Type : original article

Authors

1 Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Department of Physiology, School of Medicine, Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Metabolic Liver Disease Research Center, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: Studies suggest a potential global increase in the incidence rate of type 1 diabetes (T1D) following the SARS-CoV-2 pandemic. This study aimed to assess the incidence of T1D in Isfahan Province before and during the pandemic to better understand the situation in this population.
Methods: In this cross-sectional study, we determined the incidence rate of new-onset T1D for the two years preceding the COVID-19 pandemic (2018-2019) and during the two years of the pandemic (2020-2021). We also calculated incidence rates each year by sex and age groups (0–4 years, 5–9 years, 10–14 years, and 15–18 years).
Results: The age-adjusted incidence rates (95% CI) of T1D in Isfahan were as follows: 16.38 (16.27-16.49) in 2018, 13.94 (13.51-14.35) in 2019, 13.17 (12.44-13.90) in 2020, and 18.09 (17.17-19.00) in 2021 per 100,000 children. The average annual percent change (APC) was 9.7%, with the highest APC of 37.34% in 2021. There was no statistically significant trend in T1D incidence during the study period (P > 0.05). The frequency of diabetic ketoacidosis (DKA) was higher during the COVID-19 period in 2020 and 2021 compared to 2018, with rates of 54.89% in 2021, 52.82% in 2020, 52.68% in 2019, and 32.49% in 2018 (P < 0.005).
Conclusion: This research observed an increasing incidence rate of T1D, particularly in the second year of the COVID-19 outbreak. While other studies have also reported an increase in T1D cases, the complex nature of T1D development makes it challenging to draw definitive conclusions about the impact of SARS-CoV-2 infection on T1D onset.

Keywords

References
  1. Liu J, Ren ZH, Qiang H, Wu J, Shen M, Zhang L, et al. Trends in the incidence of diabetes mellitus: results from the Global Burden of Disease Study 2017 and implications for diabetes mellitus prevention. BMC public health. 2020 Dec;20:1-2.
  2. Nikolic A, Majcan M, Šipetic-Grujicic S. Trend of type 1 diabetes mellitus in boys and girls under 14 years of age in Belgrade in the period from 1992 to 2017: joinpoint regression analysis. Zdravstvena Za stita. 2020;49:36-49.
  3. Ilonen J, Lempainen J, Veijola R. The heterogeneous pathogenesis of type 1 diabetes mellitus. Nature Reviews Endocrinology. 2019 Nov;15(11):635-50.
  4. Paschou SA, Papadopoulou-Marketou N, Chrousos GP, Kanaka-Gantenbein C. On type 1 diabetes mellitus pathogenesis. Endocrine connections. 2018 Jan 1;7(1):R38-46.
  5. Houeiss P, Luce S, Boitard C. Environmental triggering of type 1 diabetes autoimmunity. Frontiers in Endocrinology. 2022 Jul 22;13:933965.
  6. Hyöty H. Viruses in type 1 diabetes. Pediatric diabetes. 2016 Jul;17:56-64.
  7. Hayashi T, Yoshinaka K, Hasegawa K, Maeda K, Onodera T. CpG oligodeoxynucleotides accelerate reovirus type 2‐triggered insulitis in DBA/1 suckling mice. International journal of experimental pathology. 2002 Oct;83(5):217-24.
  8. Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. American Journal of Physiology-Endocrinology and Metabolism. 2020 Apr 26.
  9. Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta diabetologica. 2010 Sep;47:193-9.
  10. Accili D. Can COVID-19 cause diabetes?. Nature metabolism. 2021 Feb;3(2):123-5.
  11. Coate KC, Cha J, Shrestha S, Wang W, Gonçalves LM, Almaça J, et al. SARS-CoV-2 cell entry factors ACE2 and TMPRSS2 are expressed in the microvasculature and ducts of human pancreas but are not enriched in β cells. Cell metabolism. 2020 Dec 1;32(6):1028-40.
  12. Rahmati M, Keshvari M, Mirnasuri S, Yon DK, Lee SW, Il Shin J, et al. The global impact of COVID‐19 pandemic on the incidence of pediatric new‐onset type 1 diabetes and ketoacidosis: a systematic review and meta‐analysis. Journal of medical virology. 2022 Nov;94(11):5112-27.
  13. Vlad A, Serban V, Timar R, Sima A, Botea V, Albai O, et al. Increased incidence of type 1 diabetes during the COVID-19 pandemic in Romanian children. Medicina. 2021 Sep 16;57(9):973.
  14. Rabbone I, Schiaffini R, Cherubini V, Maffeis C, Scaramuzza A. Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?. Diabetes care. 2020 Nov 1;43(11):2870-2.
  15. DiMeglio LA, Albanese-O'Neill A, Muñoz CE, Maahs DM. COVID-19 and children with diabetes-updates, unknowns, and next steps: first, do no extrapolation.
  16. Nygren M, Carstensen J, Koch F, Ludvigsson J, Frostell A. Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study. Diabetologia. 2015 Jun;58:1188-97.
  17. Montefusco L, Bolla AM, Fiorina P. Should we expect a wave of type 1 diabetes following SARS‐CoV‐2 pandemic?. Diabetes/Metabolism Research and Reviews. 2022 May;38(4).
  18. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2021. Diabetes care. 2021 Jan 1;44(Supplement_1):S15-33.
  19. Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJ, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. Geneva: World Health Organization. 2001 Jan 1;9(10):1-4.
  20. Kendall EK, Olaker VR, Kaelber DC, Xu R, Davis PB. Association of SARS-CoV-2 infection with new-onset type 1 diabetes among pediatric patients from 2020 to 2021. JAMA network open. 2022 Sep 1;5(9):e2233014-.
  21. Qeadan F, Tingey B, Egbert J, Pezzolesi MG, Burge MR, Peterson KA, et al. The associations between COVID-19 diagnosis, type 1 diabetes, and the risk of diabetic ketoacidosis: a nationwide cohort from the US using the Cerner Real-World Data. PLoS One. 2022 Apr 19;17(4):e0266809.
  22. van den Boom L, Kostev K, Kuss O, Rathmann W, Rosenbauer J. Type 1 diabetes incidence in children and adolescents during the COVID-19 pandemic in Germany. Diabetes Research and Clinical Practice. 2022 Nov 1;193:110146.
  23. Alaqeel A, Aljuraibah F, Alsuhaibani M, Huneif M, Alsaheel A, Dubayee MA, et al. The impact of COVID-19 pandemic lockdown on the incidence of new-onset type 1 diabetes and ketoacidosis among Saudi children. Frontiers in endocrinology. 2021 Apr 1;12:669302.
  24. Unsworth R, Wallace S, Oliver NS, Yeung S, Kshirsagar A, Naidu H. New-onset type 1 diabetes in children during COVID-19: Multicenter regional findings in the UK Diabetes Care. 2020 Nov; 43 (11): e170–1.
  25. Kamrath C, Rosenbauer J, Eckert AJ, Siedler K, Bartelt H, Klose D, et al. Incidence of type 1 diabetes in children and adolescents during the COVID-19 pandemic in Germany: results from the DPV registry. Diabetes Care. 2022 Aug 1;45(8):1762-71.
  26. McKeigue PM, McGurnaghan S, Blackbourn L, Bath LE, McAllister DA, Caparrotta TM, et al. Relation of incident type 1 diabetes to recent COVID-19 infection: cohort study using e-health record linkage in Scotland. Diabetes Care. 2023 May 1;46(5):921-8.
  27. Vorgučin I, Savin M, Stanković Đ, Miljković D, Ilić T, Simić D, et al. Incidence of type 1 diabetes mellitus and characteristics of diabetic ketoacidosis in children and adolescents during the first two years of the COVID-19 pandemic in Vojvodina. Medicina. 2022 Jul 28;58(8):1013.
  28. Weiss A, Donnachie E, Beyerlein A, Ziegler AG, Bonifacio E. Type 1 diabetes incidence and risk in children with a diagnosis of COVID-19. JAMA. 2023 Jun 20;329(23):2089-91.
  29. Knip M, Parviainen A, Turtinen M, But A, Härkönen T, Hepojoki J, et al. SARS-CoV-2 and type 1 diabetes in children in Finland: an observational study. The Lancet Diabetes & Endocrinology. 2023 Apr 1;11(4):251-60.
  30. Zhang T, Mei Q, Zhang Z, Walline JH, Liu Y, Zhu H, et al. Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis. BMC medicine. 2022 Nov 15;20(1):444.
  31. Elgenidy A, Awad AK, Saad K, Atef M, El-Leithy HH, Obiedallah AA, et al. Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes. Pediatric Research. 2023 Apr;93(5):1149-60.
  32. Shi Y, Wu LQ, Wei P, Liao ZH. Children with type 1 diabetes in COVID-19 pandemic: difficulties and solutions. World Journal of Clinical Pediatrics. 2022 Sep 9;11(5):408.
  33. Wang Y, Guo H, Wang G, Zhai J, Du B. COVID-19 as a trigger for type 1 diabetes. The Journal of Clinical Endocrinology & Metabolism. 2023 Sep;108(9):2176-83.
  34. Kloc M, Ghobrial RM, Kuchar E, Lewicki S, Kubiak JZ. Development of child immunity in the context of COVID-19 pandemic. Clinical Immunology. 2020 Aug 1;217:108510.
  35. Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proceedings of the Royal Society B: Biological Sciences. 2015 Dec 22;282(1821):20143085.
  36. Ciarambino T, Para O, Giordano M. Immune system and COVID-19 by sex differences and age. Women's Health. 2021 Jun;17:17455065211022262.
  37. Klein SL, Flanagan KL. Sex differences in immune responses. Nature Reviews Immunology. 2016 Oct;16(10):626-38.
  38. Zorena K, Michalska M, Kurpas M, Jaskulak M, Murawska A, Rostami S. Environmental factors and the risk of developing type 1 diabetes—old disease and new data. Biology. 2022 Apr 16;11(4):608..
  39. Pagano MT, Peruzzu D, Ruggieri A, Ortona E, Gagliardi MC. Vitamin D and sex differences in COVID-19. Frontiers in endocrinology. 2020 Sep 30;11:567824.
Journal of Pediatric Perspectives
Volume 13, Issue 1
January 2025
Pages 19242-19253
Files
Share
How to cite
Statistics