Study Links New Type 1 Diabetes Diagnoses, Prior COVID-19 in Pediatric Patients

Respiratory infections have been associated with onset of type 1 diabetes in previous research, but this risk was notably higher among those with COVID-19 in this study.

New research has found an association between new type 1 diabetes diagnoses and prior COVID-19 in pediatric patients, according to investigators whose findings were published in JAMA Network Open.

Earlier research had found that the incidence of new-onset type 1 diabetes increased during the COVID-19 pandemic and was associated with SARS-CoV-2 infection. CDC data suggest that pediatric patients with COVID-19 were more likely to be diagnosed with diabetes after infection, although types 1 and 2 were not separated. Therefore, investigators conducted a cohort study to determine whether there was an increase in new diagnoses of type 1 diabetes in pediatric patients after COVID-19.

The investigators obtained data using the TriNetX Analytics Platform, a database of deidentified electronic health records (EHR) of more than 90 million patients. The population was comprised of pediatric patients in 2 cohorts: those with SARS-CoV-2 infection between March 2020 and December 2021, and those with non-SARS-CoV-2 respiratory infection during the same period. The cohorts were then subdivided into groups aged 0 to 9 years of age and those aged 10 to 18 years.

The study population included 1,091,494 pediatric patients, 314,917 of whom had COVID-19 and 776,577 with non-COVID-19 respiratory infections. The matched cohort included 285,628 patients with COVID-19 and 285,628 with non-COVID-19 respiratory infections.

According to the study, by 6 months after COVID-19 infection, 123 patients had received a new diagnosis of type 1 diabetes, but only 72 were diagnosed with diabetes within 6 months of a non-COVID-19 respiratory infection. At 1, 3, and 6 months after infection, risk of diagnosis of type 1 diabetes was greater among those infected with SARS-CoV-2 compared to those with non-COVID-19 respiratory infection.

This increased risk was also noted in subgroups of patients aged 0 to 9 years and 10 to 18 years. Similar findings were noted among children infected with SARS-CoV-2 compared with other control cohorts at 6 months.

Based on these findings, the investigators said new type 1 diabetes diagnoses were more likely to occur among pediatric patients with prior COVID-19 than among those with other respiratory infections. Respiratory infections have been associated with onset of type 1 diabetes in previous research, but this risk was notably higher among those with COVID-19 in this study.

The findings raise concern for long-term, post-COVID-19 autoimmune complications among children, according to the study authors.

The study did have some limitations, such as potential biases due to the observational and retrospective design of the EHR analysis, including the possibility of misclassification of diabetes as type 1 versus type 2, and the possibility that additional unidentified factors accounted for the association.

The authors said that the results should be confirmed in other populations, but the findings add an important consideration for risk-benefit discussions for prevention and treatment of SARS-CoV-2 infection in pediatric population.


Kendall E, Olaker V, Kaelber D. Association of SARS-CoV-2 Infection With New-Onset Type 1 Diabetes Among Pediatric Patients From 2020 to 2021. JAMA Network Open. September 23, 2022. Accessed October 3, 2022.