Pediatric Diabetes

Review Article

Impact of the COVID-19 Pandemic on Children and Adolescents with New-Onset Type 1 Diabetes

Table 2

Relative increase of the incidence of type 1 diabetes (T1D) in the COVID-19 pandemic compared to prepandemic periods.


Study regions	Data sources	Age (years)	Prepandemic period		Pandemic period
			Period	Observed	Period	Observed		Expected¹		Observed vs expected	P
			Period	T1D cases	Period	T1D cases	Incidence (95% CI)²	T1D cases	Incidence (95% CI)²	Relative risk (95% CI)³	P

Al-Abdulrazzaq 2022 Kuwait	Child diabetes registry	0.5–≤12	24.02.19–23.02.20	303	24.02.20 –23.02.21	324	40.2 (36.1, 44.8)	303	37.6 (33.6, 42.1)	1.069 (0.914, 1.250)	0.403
Cinek 2022 Czechia	Czech Childhood Diabetes Register	<15	01.01.10–31.12.19	—	01.01.20–31.12.21	956	27.2 (25.5, 29.0)	824	23.4 (21.9, 25.1)	1.160 (1.060, 1.280)	0.002
Denina 2022 Italy, Piedmont	1 pediatric centre	≤14	15.10.2016–15.04.2017 15.10.2017–15.04.2018 15.10.2018–15.04.2019	97	15.10.20 –15.04.21	39	38.6 (28.2, 52.8)	24	22.5 (18.5, 27.5)	1.711 (1.180, 2.482)	0.005
Dilek 2021 South Turkey, Adana	1 pediatric centre	<18	11.03.19–10.03.20	46	11.03.20 –11.03.21	74	11.2 (8.9, 14.1)	46	6.9 (5.2, 9.2)	1.623 (1.123, 2.345)	0.010
Guo 2022 USA, Florida	OneFlorida + network electronic health records	<18	01.01.17–31.03.20	1,921	01.04.20 –30.06.21	2,354	32.6 (31.3, 33.9)	1,921	23.4 (22.7, 24.2)	1.392 (1.322, 1.465)	<0.001
Hernandez-Herrero 2022 Spain, Tarragona	3 pediatric centres	<15	01.01.18–31.12.19	52	01.01.20 –31.12.20	37	29.1 (21.1, 40.2)	26	20.4 (15.5, 26.8)	1.429 (0.937, 2.178)	0.097
Ho 2021 Canada, Alberta	2 pediatric centres	<18	17.03.19–31.08.19	114	17.03.20 –31.08.20	107	9.9 (8.2, 12.0)	114	10.6 (8.9, 12.8)	0.931 (0.715, 1.212)	0.596
Kamrath 2022 Germany	German Diabetes Prospective Follow-up Registry	0.5–<18	01.01.11–31.12.19	—	01.01.20–30.06.21	5,162	24.4 (23.6, 25.2)	4,489	21.2 (20.5, 21.9)	1.150 (1.100, 1.200)	<0.001
		0.5–<6					18.6 (17.5, 19.8)		15.1 (14.1, 16.2)	1.230 (1.130–1.330)	<0.001
		6–<12					32.7 (31.2, 34.3)		27.7 (26.3, 29.2)	1.180 (1.110–1.260)	<0.001
		12– < 18					23.5 (22.2, 24.8)		22.2 (21.0, 23.5)	1.060 (0.980–1.130)	0.13
Mameli 2021 Italy, Lombardy	13 pediatric centres	≤17	01.01.19–31.12.19	231	01.01.20 –31.12.20	256	16.0 (14.2, 18.1)	231	14.0 (12.9, 15.1)	1.143 (0.957, 1.365)	0.141
McKeigue 2022 UK, scotland	Diabetes registry	≤14	01.01.15–31.12.21	—	01.01.20 –31.12.21	—	—	—	—	1.200	—
Pietropaolo 2022	TriNetX COVID-19 research network, electronic 60 healthcare organization	≤30	01.01.18–31.12.19	27,704	01.03.20–15.07.21	21,925	30.1 (29.7, 30.5)	20,308	27.9 (27.6, 28.2)	1.080 (1.061, 1.099)	<0.001
Pietrzak 2022 Poland	14 paediatric centres	≤18	15.03.19–14.03.20	1,391	15.03.20– 15.03.21	1,671	25.9 (24.7, 27.2)	1,391	21.6 (20.4, 22.7)	1.202 (1.119, 1.290)	<0.001
Salmi 2022 Finland	Helsinki University Hospital	≤15	01.04–31.10	231	01.04.20–31.10.20	84	56.0 (45.2, 69.3)	58	38.7 (34.0, 44.0)	1.450 (1.130, 1.860)	0.004
Shulman 2022⁴ Canada, Ontario	Health insurance data	1–17	01.01.17–29.02.20	—	01.03.20–30.09.21	1,570	36.7 (35.0, 38.6)	1,440	33.7 (32.0, 35.5)	1.090 (0.910, 1.300)	>0.05
VandenBoom 2022 Germany	IQVIA prescription database (LRx)	≤20	04.01.16−01.03.20	16293	02.03.20−02.01.22	7492	26.7 (26.1, 27.3)	5992	21.2 (20.7, 21.8)	1.259 (1.217, 1.303)	<0.001
			06–08	3,447	06.2020–08.2020	990	25.9 (24.1, 27.8)	689	18.0 (16.5, 19.6)	1.440 (1.130, 1.580)	<0.001
			In 2016–2019		05.2021–08.2021	1036	27.1 (25.3, 29.1)	629	16.5 (15.0, 18.0)	1.650 (1.490, 1.820)	<0.001
Vlad 2021⁵ Romania	Child diabetes registry	<15	01.01.19–31.12.19	—	01.01.20–31.12.20	403	13.3 (12.1, 14.7)	347	11.4 (10.3, 12.7)	1.166 (1.010, 1.345)	0.036

Figures in italics were recalculated based on data reported in the original articles. ¹Expected incidences of T1D for the pandemic period under study were estimated from observed incidences for the related prepandemic period. ²Per 100,000 person-years. ³Estimated as ratio of observed and expected incidences. ⁴No differentiation between type 1 and type 2 diabetes (but 95% of children with diabetes in Ontario have type 1 diabetes). ⁵To estimate T1D case numbers, we used population data from EUROSTAT (https://ec.europa.eu/eurostat/databrowser/view/DEMO_PJANGROUP__custom_4092331/default/table?lang=en).