ESPE Yearbook of Paediatric Endocrinology

Diabetes Care. 2020;43(11):e172–e173. doi: 10.2337/dc20-1633

During the first phase of the COVID-19 pandemic, the DPV (the German diabetes registry database) study group asked whether or not the COVID-19 lockdown had affected the incidence of pediatric T1D in Germany (1). More than 210 German pediatric diabetes centers contributed their data on pediatric patients with T1D with an onset at ages between 6 months and <18 years diagnosed between 13 March and 13 May in each year between 2011 and 2020. The latter period corresponds to the first COVID-19 lockdown period in Germany in 2020. T1D incidence increased from 16.4 [95% CI 14.7–18.2] in 2011 to 22.2 [20.3–24.2] in 2019 (P=0.04). The incidence in 2020, based on 532 cases among 13.6 million subjects <18 years, was 23.4 [21.5–25.5] and did not differ significantly from the prediction (22.1 [20.4–23.9]). It can be concluded that T1D incidence in 2020 followed the increasing trend observed between 2011 and 2019 without any observable up- or downward deviation.

There is no sign that the COVID-19 pandemic influenced the incidence of diabetes in youth in the short term. Therefore, direct diabetogenic and even islet destroying effects of the COVID-19 virus itself seem unlikely. However, subtle and or indirect effects cannot be excluded given the relatively low COVID-19 infection rate in children in Germany during the study period. In addition and importantly it remains unclear whether or not elevated stress levels and/or reduced infection rates may actually outweigh each other regarding any putative effects on the onset of T1D in children and adolescents or as an alternative there may indeed be no measurable impact on incidence. In addition, there may be a time delay between immunologic factors or infections and the onset of T1D. Epidemiologic differences, confounding factors and delays in reporting are known to have occurred during lockdown periods and may have influenced these results (1).

Reference: 1. Vogel M, Beger C, Gausche R, Jurkutat A, Pfaeffle R, Körner A, Meigen C, Poulain T, Kiess W. COVID-19 pandemic and families’ utilization of well-child clinics and pediatric practices attendance in Germany. BMC Res Notes. 2021;14(1):140. doi: 10.1186/s13104-021-05562-3.