A new study shows that COVID-19 infections in children lead to a significantly higher risk of type 2 diabetes within six months, sparking fresh concerns about the long-term impacts of the virus on young populations.

Study: SARS-CoV-2 Infection and New-Onset Type 2 Diabetes Among Pediatric Patients, 2020 to 2022. Image Credit: Neirfy / Shutterstock

In a recent study published in JAMA Network Open, researchers at Case Western Reserve University, USA, assessed the risk of type 2 diabetes (T2D) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children.

SARS-CoV-2 infection is associated with subsequent chronic illnesses. A meta-analysis reported a 66% increased risk of new-onset diabetes in adults after coronavirus disease 2019 (COVID-19). Several reports suggest this risk is much greater in males and those with severe COVID-19. Moreover, increased diabetes incidence post-COVID-19 has been reported among people younger than 18.

Some studies have also noted associations between COVID-19 and the risk of new-onset type 1 diabetes (T1D) in children. In addition, increases in other disorders post-COVID-19, such as myocarditis, multisystem inflammatory syndrome, etc., have been documented in children. T2D incidence rates in children had increased worldwide before the COVID-19 pandemic. However, research on T2D incidence post-COVID-19 in children has been limited.

About the study

In the present study, researchers evaluated the risk of T2D in children following COVID-19 diagnosis relative to the risk of other non-COVID-19 respiratory infections (ORIs). They used electronic health record (EHR) data of children aged 10–19 with a respiratory illness (COVID-19 or ORI) between 2020 and 2022. Children with a positive test for SARS-CoV-2 were included in the COVID-19 cohort.

Subjects with influenza, pneumonia, or other acute lower/upper respiratory tract infections were included in the ORI cohort. To assess effect modification by body mass index (BMI), a subset of patients with documented obesity or overweight before the index event was compared. In addition, subsets of patients with ORI or COVID-19 hospitalizations identified by an inpatient visit anytime from one week before to one month after the index event were compared.

Besides, the team assessed T2D risk in the COVID-19 cohort relative to a non-viral cohort. The non-viral cohort included patients with common non-infectious reasons for medical encounters, such as acne vulgaris, arm or shoulder fracture, eye/vision examination, etc. The cumulative risk of T2D was measured at several time points after ORI or COVID-19.

In addition, supplemental analyses were conducted to exclude early T2D diagnoses within one and three months after the respiratory event, ensuring that pre-existing cases were not mistaken for new diagnoses. This helped to account for potential bias arising from undiagnosed T2D being discovered during COVID-related hospital visits. Propensity-score matching was applied to match cohorts for demographics, T2D risk factors, cholesterol levels, autoimmune risk factors, and other diagnoses reported to be correlated with increased T2D risk. The risk of new T2D diagnoses after COVID-19 was compared between cohorts using risk ratios and 95% confidence intervals.

Findings

The COVID-19 and ORI cohorts included 306,801 patients each. The COVID-19 cohort comprised 47.1% males and 52.8% females, averaging 14.9 years; 56.8% were White, 18.9% were Black, 3% were Asian, and 20.8% were multiracial/others. The ORI cohort comprised 47.3% males and 52.6% females aged 14.9, on average; 57.1% of ORI patients were White, 21.3% were multiracial/others, 17.6% were Black, and 15.5% were Hispanic.

The cumulative risk of T2D was significantly higher for the COVID-19 cohort than for the ORI cohort at one, three, and six months after the respiratory event. The subset of patients with obesity or overweight included 16,469 individuals in each of the COVID-19 and ORI cohorts. In this subset, COVID-19 was significantly associated with an elevated risk of T2D at each follow-up time point relative to ORI.

When analyses were restricted to the subgroup with an inpatient visit within a month of ORI or COVID-19, the risk of T2D was similarly elevated at all time points. Consistently, in supplemental analyses that excluded T2D diagnoses up to three months after the respiratory event, there was a significantly higher risk of T2D after COVID-19 than after ORI. In comparisons with the non-viral cohort, estimates were comparable to those of the primary study population.

Conclusions

In sum, pediatric patients aged 10–19 with COVID-19 were more likely to be diagnosed with T2D during the six months after the infection compared to those with ORIs. This risk was also evident in subsets who were obese or overweight and those who were hospitalized. The risk was sustained when excluding (T2D) diagnoses documented up to three months after the respiratory event.

Although some reports suggested a higher risk of T2D for adult males, this analysis did not observe such sex-based differences in children. Furthermore, the study raised the possibility that SARS-CoV-2 infection may trigger autoimmune responses, such as the production of anti-β-cell antibodies in genetically susceptible children, potentially contributing to the onset of T2D.

The study’s limitations include its observational nature (which precludes determining causation), unmeasurable confounding factors, and the use of EHR data (which is subject to misdiagnosis, overdiagnosis, and underdiagnosis).