2023-09-04 17:52:08
The relationship between type 1 diabetes, the least frequent, and the Covid-19 infection seems increasingly evident.
A study of more than 38,000 young people confirms what researchers had begun to suspect: the covid pandemic precipitated the increase in cases of type 1 diabetes in children and adolescents. At first, the researchers thought the increase was caused by the virus itself, but that’s probably not true.
The study, publishedJAMA Network Open», pooled data from 17 previous studies and found that the incidence of type 1 diabetes in children and adolescents under 19 years of age was approximately 14% higher during 2020, the first year of the pandemic, than the year before. The incidence increased even more in the second year of the pandemic, 27% more than in 2019.
The data coincides with another large study carried out on more than 1 million children presented during the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Stockholm (Sweden).
“This is a much higher incidence than we expected,” says lead author Rayzel Shulman, of the SickKids Research Institute in Toronto, (Canada). Before covid, the incidence of type 1 diabetes in children was increasing at a constant rate of around 2% to 4% per year.
Type 1 diabetes occurs when the body’s own immune system attacks cells in the pancreas that produce insulin, which regulates blood sugar levels. As a result, blood sugar levels can swing dangerously. In the long term, this can damage people’s blood vessels, which in turn can lead to blindness, kidney failure, heart attacks, or nerve damage that, in the worst case, requires the amputation of a limb.
In Spain, there is no specific data on how many new cases of type 1 diabetes have been diagnosed as a result of the pandemic, acknowledges Virginia Bellido, from the Spanish Diabetes Society.
However, he adds, there have been different studies that have documented an increased incidence of type 1 diabetes cases during the pandemic and, in addition, “many of these cases have presented with a higher incidence of ketoacidosis.” [se produce cuando el cuerpo no tiene suficiente insulina para permitir que el azúcar en la sangre ingrese a las células para usarlo como energía probablemente debido]at own restrictions of the pandemic».
The incidence of diabetic ketoacidosis, a life-threatening complication of new-onset type 1 diabetes, increased 26% between 2019 and 2020, likely because people were hesitant or unable to seek emergency care when symptoms first appeared. Diabetic ketoacidosis is preventable, but it has long-lasting effects if it occurs, so “eThat is actually one of the most important findings of this study.says Shulman.
Despite the fact that numerous studies have tried to find evidence that SARS-CoV-2 was triggering the increase or substantially damaging pancreatic cells, the response has not been satisfactory.
Bellido explains that initially there was talk of an increase in the incidence of diabetes cases due to a direct effect of the virus related to the destruction of pancreatic beta cells. “But this is not clear today.”
Other factors that could be influential are the factors inherent to the pandemic, such as changes in lifestyle, changes in the patterns of infections in pediatrics or in situations, or an increase in stress associated with the pandemic. «But the exact causes that have led to this increase in incidence, to this day, are not clear.assures this endocrinologist of the Virgen del Rocío University Hospital (Sevilla)
Shulman and his colleagues limited their analysis to studies that had 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 confirming that the incidence of type 1 diabetes in children increased during the first two years of the pandemic, they also found that the pandemic altered the seasonality of childhood type 1 diabetes.. The disease usually follows clear seasonal patterns, with more new cases being diagnosed in the winter months than in the summer months.
The Sevillian expert comments that it is true that there is usually a higher incidence during the winter months and it seems that with the Covid pandemic this seasonality is lost. The reasons? “There is nothing clear either,” he replies. He points out that in the coming years it will be seen if this seasonal pattern has been broken.
Type 2 diabetes develops when the pancreas does not produce enough insulin and the body stops responding to it. Inactivity and obesity are risk factors.
It’s not clear what triggered the sudden rise in diabetes and how long the trend might persist
Rayzel Shulman
SickKids Research Institute
The meta-analysis reaffirmed that children diagnosed with type 1 diabetes tended to have more severe forms of the disease during the pandemic than before.
It’s not yet clear what triggered the diabetes surge and how long the trend might persist, Shulman acknowledges.
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, believes that a 14% increase in incidence in just one year “seems implausible to me.”
As for the underlying causes, Kamrath, who wrote an invited commentary on the meta-analysis, says it now seems “quite unlikely” that SARS-CoV-2 is directly damaging pancreatic cells in children.
If the parallel pandemic of diabetes isn’t caused by the virus wiping out pancreatic cells, Shulman says, it opens up an opportunity for researchers to investigate other factors that could be driving the decades-long rise in childhood diabetes.
Thirunavukkarasu notes that the most likely explanation is that the immune system’s attack on the pancreas is “triggered by a COVID-19 infection, which is also the case with other infections, such as enteroviruses and hepatitis B.”
We do not know exactly what is the direct mechanism that would link infection by this virus two and the development of type 1 diabetes.
Virginia Bellido
Spanish Diabetes Society.
It could be that the pandemic has accelerated the onset of type 1 diabetes in children who were already at risk or that, for unknown reasons, more children are developing autoimmunity than before the pandemic, Shulman says.
Lockdowns and physical distancing could have reduced children’s exposure to respiratory viruses other than Covid-19, inadvertently removing an unknown protective effect, it adds.
Bellido believes that the exact etiology of type 1 diabetes is unknown. Both genetic and environmental susceptibility factors have been described, and among these environmental factors, in addition to some such as diet, are viral infections. However, the SED expert qualifies, “nor there is direct evidence that a particular virus strain is a direct cause of type 1 diabetesalthough different infections have been described as possible triggers for type 1 diabetes and here would be, for example, SARS-Cov2, but we do not know exactly what is the direct mechanism that would link infection by this two virus and the development of the Diabetes type 1″.
Researchers are exploring other potential triggers, including diets rich in highly processed foods, weight gain, and changes in immune-influencing microorganisms that live in the gut. «There is no single answer to this.”they conclude.
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