Risk for Newly Diagnosed Diabetes >30 Days after COVID-19 Infection among Children Aged <18 Years
Children who are infected with COVID-19 are at a higher risk of developing diabetes, according to a new study by the Centers for Disease Control and Prevention (CDC). Increased incidence of diabetes seen among patients aged younger than 18 years after acute COVID-19 infection versus those without COVID-19.
Key Summary
What is already known about this topic?
SARS-CoV-2 infection is associated with worsening of diabetes symptoms, and persons with diabetes are at increased risk for severe COVID-19. SARS-CoV-2 infection might also induce newly diagnosed diabetes.
What is added by this report?
Persons aged <18 years with COVID-19 were more likely to receive a new diabetes diagnosis >30 days after infection than were those without COVID-19 and those with prepandemic acute respiratory infections. Non–SARS-CoV-2 respiratory infection was not associated with an increased risk for diabetes.
What are the implications for public health practice?
The increased diabetes risk among persons aged <18 years following COVID-19 highlights the importance of COVID-19 prevention strategies in this age group, including vaccination for all eligible persons and chronic disease prevention and treatment.
Vaccinations, masking, and social distancing measures can help protect both adults and children from COVID-19 infection and complications.
Health care providers should screen for diabetes symptoms in persons aged < 18 years with a history of SARS-CoV-2 infection.
Warning Signs & Symptoms
Signs & symptoms of diabetes may include frequent urination, increased thirst, increased hunger, weight loss, tiredness or fatigue, stomach pain, and nausea or vomiting.
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Objective:
The COVID-19 pandemic has disproportionately affected people with diabetes, who are at increased risk of severe COVID-19. Increases in the number of type 1 diabetes diagnoses and increased frequency and severity of diabetic ketoacidosis (DKA) at the time of diabetes diagnosis have been reported in European pediatric populations during the COVID-19 pandemic. In adults, diabetes might be a long-term consequence of SARS-CoV-2 infection.
Method:
To evaluate the risk for any new diabetes diagnosis (type 1, type 2, or other diabetes) >30 days after acute infection with SARS-CoV-2, CDC estimated diabetes incidence among patients aged <18 years (patients) with diagnosed COVID-19 from retrospective cohorts constructed using IQVIA health care claims data from March 1, 2020, through February 26, 2021, and compared it with incidence among patients matched by age and sex 1) who did not receive a COVID-19 diagnosis during the pandemic, or 2) who received a pre-pandemic non–COVID-19 acute respiratory infection (ARI) diagnosis.
Results:
New diabetes diagnoses were 166% (IQVIA) and 31% (HealthVerity) more likely to occur among patients with COVID-19 than among those without COVID-19 during the pandemic and 116% more likely to occur among those with COVID-19 than among those with ARI during the prepandemic period. Non–SARS-CoV-2 respiratory infection was not associated with diabetes.
These findings are consistent with previous research demonstrating an association between SARS-CoV-2 infection and diabetes in adults.
The inclusion of only patients aged <18 years with a health care encounter possibly related to COVID-19 in the non–COVID-19 HealthVerity group could account for the lower magnitude of increased diabetes risk in this group compared with risk in the IQVIA group. In addition, patients without COVID-19 in HealthVerity had higher hospitalization rates than did those in IQVIA, suggesting more severe disease at the index encounter in the HealthVerity comparison group.
Conclusions:
Among these patients, diabetes incidence was significantly higher among those with COVID-19 than among those 1) without COVID-19 in both databases with non–COVID-19 ARI in the prepandemic period. The observed increased risk for diabetes among persons aged <18 years who had COVID-19 highlights the importance of COVID-19 prevention strategies, including vaccination, for all eligible persons in this age group, in addition to chronic disease prevention and management.
The mechanism of how SARS-CoV-2 might lead to incident diabetes is likely complex and could differ by type 1 and type 2 diabetes. Monitoring for long-term consequences, including signs of new diabetes, following SARS-CoV-2 infection is important in this age group.
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