Higher Rates of T1D Among Finnish Children During COVID-19 Pandemic

During the COVID-19 pandemic, children in Finland were significantly more likely to receive a type 1 diabetes (T1D) diagnosis, and more likely to receive the diagnosis at a more advanced disease state.

These findings were published in The Lancet Diabetes & Endocrinology, and are presented in comparison with a pre–COVID-19 reference period stretching from March 2014 to August 2019.

The observational cohort study used data from the Finnish Pediatric Diabetes Register (FPDR). The data showed that 785 children younger than 15 years in Finland received a T1D diagnosis in the first 18 months of the COVID-19 pandemic, between March 2020 and August 2021. The reference period consisted of 3 other 18-month periods from earlier years: one from March 2014 to August 2015, another from March 2016 to August 2017, and a third from March 2018 to August 2019. During these 3 periods collectively, 2096 Finnish children received a T1D diagnosis.

During the pandemic, T1D incidence was 61.0 per 100,000 person-years (95% CI, 56.8-65.4), which was significantly higher compared with the reference period at 52.3 per 100,000 person-years (95% CI, 50.1-54.6).

When adjusted for age and sex, the T1D incidence ratio during the first 18 months of the COVID-19 pandemic was 1.16 (95% CI, 1.06-1.25; P = .0006), compared with the reference period, marking a 16% increase in T1D diagnoses.

Children who received a T1D diagnosis during the pandemic also had more severe metabolic decompensation. These children were more likely to have diabetic ketoacidosis (P < .001) and higher hemoglobin A_1c (P < .001), and they more frequently tested positive for glutamic acid debarboxylase antibodies at the time of diagnosis (P < .001), compared with the reference period.

The authors noted that similar observations have been reported in other studies in other countries.

Additionally, testing positive for glutamic acid debarboxylase (GAD) antibodies—which are reportedly linked to a slow progression to T1D—was more common among children with T1D during the COVID-19 pandemic.

“The increased frequency of GAD antibodies among those diagnosed with type 1 diabetes during the COVID-19 pandemic might indicate that the proportion of those with slowly progressing disease is increased in the pandemic cohort,” they said.

The authors also emphasized that these observed differences are not a direct effect of COVID-19 infection itself, but rather a consequence of lockdown and physical distancing, especially reduced hospital visits for conditions unrelated to COVID-19. Of 583 children in this group who were tested for SARS-CoV-2 antibodies, only 5 of them tested positive.

The authors also found no significant differences in the distribution of human leukocyte antigen genotypes—which play a major role in the development of a specific immune response to viral infections—between the pandemic and reference periods.

Reference

Knip M, Parviainen A, Turtinen M, et al; Finnish Pediatric Diabetes Register. SARS-CoV-2 and type 1 diabetes in children in Finland: an observational study. Lancet Diabetes Endocrinol. 2023;11(4):251-260. doi:10.1016/S2213-8587(23)00041-4