January 21, 2022
3 min read
Children who had a COVID-19 infection have a higher risk for developing diabetes compared with those who did not contract COVID-19, according to study findings published in Morbidity and Mortality Weekly Report.
In an analysis of more than 2 million children in two U.S. medical claims databases, diabetes incidence rates were greater for children and adolescents who had COVID-19 from March 1, 2020, to June 28, 2021, compared with a cohort without COVID-19 as well as a cohort of children with a pre-pandemic non-COVID-19 acute respiratory infection.
“Children who have had COVID-19 were up to 2.5 times more likely to receive a new diagnosis of diabetes after infection,” Sharon Saydah, PhD, MHS, USPHS, senior scientist for the CDC, told Healio. “Nearly half had diabetic ketoacidosis at time of diabetes diagnosis, a serious diabetes complication, at a much higher rate than previously reported. It is important for health care providers to be aware of the signs and symptoms of diabetes and monitor for new diabetes in this group.”
Saydah and colleagues analyzed data from children aged 17 years and younger in the IQVIA and HealthVerity medical claims databases. Four cohorts were formed from the IQVIA database. The first consisted of 80,893 children with a COVID-19 diagnosis from March 1, 2020, to Feb. 26, 2021. A group of children without a COVID-19 diagnosis from March 1, 2020, to Feb. 26, 2021, and a group of children with an acute respiratory infection before the pandemic from March 1, 2017, to Feb. 26, 2018, were matched 5:1 with the COVID-19 cohort. A final cohort of children without an acute respiratory infection from March 1, 2017, to Feb. 26, 2018, was matched 2:1 with the pre-pandemic acute respiratory infection group. In the HealthVerity database, 439,439 children with a COVID-19 diagnosis or positive COVID-19 test from March 1, 2020, to June 28, 2021, were matched with a group of children without COVID-19 during the same period. Incident diabetes was defined as a health care claim with a diabetes diagnosis at least 30 days after the cohort’s index date.
Diabetes risk higher after COVID-19
Diabetes was reported in 0.08% of those with COVID-19 and 0.03% without COVID-19 in the IQVIA database. In HealthVerity, 0.25% of those with COVID-19 and 0.19% without COVID-19 had diabetes. DKA was reported in 48.5% of children in IQVIA with COVID-19 compared with 13.6% without COVID-19, and in 40.2% of those with COVID-19 in HealthVerity compared with 29.7% without COVID-19.
In IQVIA, children with COVID-19 had a higher risk for developing diabetes compared with those without COVID-19 (HR = 2.66; 95% CI, 1.98-3.56) and those with pre-pandemic acute respiratory infection (HR = 2.16; 95% CI, 1.64-2.86). There was no significant difference in diabetes incidence in the pre-pandemic acute respiratory infection group compared with the group without pre-pandemic acute respiratory infection. In HealthVerity, the risk for diabetes among those with COVID-19 was greater than those without COVID-19 (HR = 1.31; 95% CI, 1.2-1.44).
“There are a number of potential reasons why a previous COVID-19 infection could increase risk for diabetes in kids,” Saydah said. “This could be due to direct attack of SARS-CoV-2 on pancreatic cells expressing angiotensin-converting enzyme 2 receptors, through stress hyperglycemia from cytokine storm and alteration in glucose metabolism from infection or through precipitation of prediabetes to diabetes.”
The risk for diabetes was similar across age groups and sex in the IQVIA cohorts. For HealthVerity, COVID-19 was not associated with a difference in diabetes risk for children younger than 12 years, but an increased risk for diabetes in those with COVID-19 was observed for all other age and sex groups.
Longer-term studies needed
Saydah noted the study did not examine all of the factors that could have affected the association between COVID-19 and diabetes, such as race and ethnicity and the presence of prediabetes. While longer-term follow-up studies are needed, Saydah said, the data should implore parents to take precautions with protecting their children from contracting COVID-19.
“Parents can help protect their children from possible effects of the disease by slowing the spread of COVID-19 among children and teens through vaccinations for children who are eligible and behaviors such as mask wearing,” Saydah sad. “It is also important for parents and health care providers to be aware of the signs and symptoms of diabetes and seek care.”
For more information:
Sharon Saydah, PhD, MHS, USPHS, can be reached at [email protected]