ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatr Diabetes. 2020;21(3):456–459.

For many years, infections have been thought to trigger the onset of type 1 diabetes (T1DM) or even to be one of the causes of autoimmune processes that eventually lead to the destruction of the pancreatic beta-cell. In particular, maternal rubella virus infections during pregnancy are reported to increase the risk of T1DM in children, and fetal rubella infection leads to higher risk of T1DM in those affected. Widespread rubella vaccination has decreased the number of infants with congenital rubella syndrome in many countries, although it remains a problem in developing countries.

This paper describes the association between congenital infections and subsequent diabetes risk in children in the United States using data from a nationwide private health insurer for the years 2001–2017. In total 1 475 587 infants were followed for on average 3.9 years. Information was obtained regarding congenital infections (rubella, cytomegalovirus, other congenital infections) perinatal infections, and the development of diabetes mellitus and diabetic ketoacidosis. 781 infants with congenital infections and 73 974 with perinatal infections were identified. Diabetes developed in 3334 children. The odds of developing diabetes for children with history of congenital rubella infection was 12-fold higher (P =0.013) and for children with congenital cytomegalovirus infection were 4-fold higher (P =0.011) than for those without infection. Children with other congenital infections had 3-fold higher odds of developing diabetes (P =0.044). Results were similar for diabetes ketoacidosis. Children with history of other perinatal infections had a 49% higher odds of developing diabetes (P <0.001).

It is to be concluded that this insurance register-based study shows that congenital and other perinatal infections are associated with higher risks of developing diabetes mellitus during childhood. Hence, vaccination against rubella remains an important preventive action to reduce the incidence of diabetes in children.

From earlier studies prior to vaccination, we know that especially congenital rubella infection increased the risk of development of T1DM in children. Rubella remains an important public health issue, especially in developing countries. Many other congenital infections cannot be prevented by vaccination as yet. Even for preventable infections, vaccine hesitancy is not uncommon, especially in US and Europe. In this US study, even if the absolute numbers of congenital infections were low, the increased risk of diabetes was significant and sizeable. Interestingly also perinatal infections increased this risk (with a lower effect). The authors recommend a vaccination program for women of childbearing age, especially regarding rubella.