COVID-19 Pandemic Accelerates Onset of Clinical Type 1 Diabetes

The autoimmune disease type 1 diabetes can be detected before the symptomatic clinical onset by screening for islet autoantibodies in the blood. The presence of two or more islet autoantibodies indicates an early stage of type 1 diabetes. The Fr1da screening in Bavaria, Germany, led by Helmholtz Munich identifies children with islet autoantibodies. Early detection at a presymptomatic stage is necessary to provide affected children and families with information, education, and monitoring to prevent severe metabolic decompensation at clinical manifestation and optimize the start of insulin treatment.

SARS-CoV-2 Virus Increases Type 1 Diabetes Islet Autoimmunity Risk and Disease Progression

From the start of the COVID-19 pandemic in 2020 until 2023, children participating in the Fr1da study were tested for SARS-CoV-2 antibodies in addition to islet autoantibodies. This resulted in valuable data on the association between the SARS-CoV-2 virus and type 1 diabetes. The researchers previously demonstrated in another study a temporal relationship between a SARS-CoV-2 infection and the development of islet autoimmunity. The incidence of islet autoantibodies was elevated in young children after a SARS-CoV-2 infection. In the present study, the scientists now further reveal that a SARS-CoV-2 infection can accelerate the progression to clinical type 1 diabetes in children with pre-existing islet autoimmunity.

Data from the follow-up program of children in the German Fr1da study was evaluated. The program monitored children with early-stage type 1 diabetes until they were diagnosed with type 1 diabetes. The researchers showed an increase in the incidence rate of type 1 diabetes among children with presymptomatic type 1 diabetes once the pandemic started as compared to the pre-pandemic period. The children who were infected with SARS-CoV-2 progressed faster to clinical type 1 diabetes than those who did not experience an infection. Additional studies are needed to establish if this effect is also present in adolescents or adults, and whether vaccination should be recommended for individuals with presymptomatic type 1 diabetes.