New‐onset type 1 diabetes in children and adolescents as postacute sequelae of SARS‐CoV‐2 infection: A systematic review and meta‐analysis of cohort studies

Author:

Rahmati Masoud1ORCID,Yon Dong Keon23ORCID,Lee Seung Won4ORCID,Udeh Raphael5,McEVoy Mark56,Kim Min Seo7,Gyasi Razak M.89,Oh Hans10,López Sánchez Guillermo F.11ORCID,Jacob Louis121314,Li Yusheng15,Koyanagi Ai121316,Shin Jae Il17ORCID,Smith Lee18

Affiliation:

1. Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences Lorestan University Khoramabad Iran

2. Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center Kyung Hee University College of Medicine Seoul Republic of Korea

3. Department of Pediatrics Kyung Hee University College of Medicine Seoul Republic of Korea

4. Department of Precision Medicine Sungkyunkwan University School of Medicine Suwon Republic of Korea

5. School of Medicine and Public Health University of Newcastle New South Wales Australia

6. La Trobe Rural Health School, College of Science, Health and Engineering La Trobe University Victoria Australia

7. Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University Samsung Medical Center Seoul Republic of Korea

8. African Population and Health Research Center Nairobi Kenya

9. National Centre for Naturopathic Medicine, Faculty of Health Southern Cross University Lismore New South Wales Australia

10. Suzanne Dworak Peck School of Social Work University of Southern California Los Angeles California USA

11. Division of Preventive Medicine and Public Health, Department of Public Health Sciences University of Murcia Murcia Spain

12. Research and Development Unit Parc Sanitari Sant Joan de Déu Barcelona Spain

13. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII Madrid Spain

14. Department of Physical Medicine and Rehabilitation, Lariboisière‐Fernand Widal Hospital, AP‐HP Université Paris Cité Paris France

15. Deparment of Orthopedics, Xiangya Hospital Central South University Hunan China

16. Institució Catalana de Recerca i Estudis Avançats (ICREA) Barcelona Spain

17. Department of Pediatrics Yonsei University College of Medicine Seoul Republic of Korea

18. Centre for Health, Performance, and Wellbeing Anglia Ruskin University Cambridge UK

Abstract

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in children and adolescents may increase risk for a variety of post‐acute sequelae including new‐onset type 1 diabetes mellitus (T1DM). Therefore, this meta‐analysis aims to estimate the risk of developing new‐onset type 1 diabetes in children and adolescents as post‐acute sequelae of SARS‐CoV‐2 infection. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched up to March 20, 2023. A systematic review and subsequent meta‐analyses were performed to calculate the pooled effect size, expressed as risk ratio (RR) with corresponding 95% confidence interval (CI) of each outcome based on a one‐stage approach and the random‐effects estimate of the pooled effect sizes of each outcome were generated with the use of the DerSimonian‐Laird method. Eight reports from seven studies involving 11 220 530 participants (2 140 897 patients with a history of diagnosed SARS‐CoV‐2 infection and 9 079 633 participants in the respective control groups) were included. The included studies reported data from four U.S. medical claims databases covering more than 503 million patients (IQVIA, HealthVerity, TriNetX, and Cerner Real‐World Data), and three national health registries for all children and adolescents in Norway, Scotland, and Denmark. It was shown that the risk of new‐onset T1DM following SARS‐CoV‐2 infection in children and adolescents was 42% (95% CI 13%−77%, p = 0.002) higher compared with non‐COVID‐19 control groups. The risk of developing new‐onset T1DM following SARS‐CoV‐2 infection was significantly higher (67%, 95% CI 32 %–112%, p = 0.0001) in children and adolescents between 0 and 11 years, but not in those between 12 and 17 years (RR = 1.10, 95% CI 0.54–2.23, p = 0.79). We also found that the higher risk for developing new‐onset T1DM following SARS‐CoV‐2 infection only exists in studies from the United States (RR = 1.70, 95% CI 1.37−2.11, p = 0.00001) but not Europe (RR = 1.02, 95% CI 0.67−1.55, p = 0.93). Furthermore, we found that SARS‐CoV‐2 infection was associated with an elevation in the risk of diabetic ketoacidosis (DKA) in children and adolescents compared with non‐COVID‐19 control groups (RR = 2.56, 95% CI 1.07−6.11, p = 0.03). Our findings mainly obtained from US medical claims databases, suggest that SARS‐CoV‐2 infection is associated with higher risk of developing new‐onset T1DM and diabetic ketoacidosis in children and adolescents. These findings highlight the need for targeted measures to raise public health practitioners and physician awareness to provide intervention strategies to reduce the risk of developing T1DM in children and adolescents who have had COVID‐19.

Publisher

Wiley

Subject

Infectious Diseases,Virology

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