Covid pandemic linked to surge in child and teen diabetes

[Bruce Stephens]

Some of the rise could be attributed to catch-up - from backlogs and delays when health services were shut - but does not explain all of the newly diagnosed cases, say scientists.​

Before the pandemic, the incidence rate of childhood type 1 diabetes was already increasing - by about 3% a year.​

The recent study found:​

• there was a 14% rise in the rate during the first year of the pandemic, compared to before Covid
• in the second year of Covid, the rate was up about 27% on pre-pandemic levels

Covid pandemic linked to surge in child and teen diabetes

Experts have seen a 'substantial' yet unexplained rise in new cases worldwide since the pandemic.

www.bbc.co.uk

 

[Bubbleblower]

Here is the reason why (I am not an expert like the guys in the article):



After they closed schools and gyms etc. the percentage of overweight (schoolgoing) kids rapidly increased by ~25% (the lower blue and green lines). When they were opened again they dropped just as fast.

The graph also shows when most people get diabetes, which is when they leave the house.

 

[Robin]

Here is the reason why (I am not an expert like the guys in the article):

View attachment 26480

After they closed schools and gyms etc. the percentage of overweight (schoolgoing) kids rapidly increased by ~25% (the lower blue and green lines). When they were opened again they dropped just as fast.

The graph also shows when most people get diabetes, which is when they leave the house.

The article cited in @Bruce Stephens 's post is talking about Type 1 diabetes (though it doesn’t make that clear in the title of the article, sloppy journalism again). Type 1 diabetes is an Autoimmune condition, and not linked to being overweight. This is explained in the article, together with some theories about why it might be on the increase, none of which have been investigated yet.

 

[trophywench]

Well - I suppose so, really, cos all this isolating and lack of social mixing anyway does weaken anyone's immune system - so kids had no exposure to things like measles or chicken pox etc, coughs, colds, gastric upsets and other normal bugs which when they're healthy and also getting shedloads of exercise before after and during school, their immune systems would naturally fight against and thus become stronger in that very process. So the weakened immune system meets an auto-immune attack with a depleted arsenal to fight against it .......

 

[Bloden]

I wonder why they're just monitoring the situation with children and young people. It'd be interesting to see if the number of adults becoming T1 has gone up too.

 

[SB2015]

The article cited in @Bruce Stephens 's post is talking about Type 1 diabetes (though it doesn’t make that clear in the title of the article, sloppy journalism again). Type 1 diabetes is an Autoimmune condition, and not linked to being overweight. This is explained in the article, together with some theories about why it might be on the increase, none of which have been investigated yet.

It would also be interesting to know if there has been an increase in other Autoimune diseases, such as Celliac.

 

[Bruce Stephens]

I wonder why they're just monitoring the situation with children and young people. It'd be interesting to see if the number of adults becoming T1 has gone up too.

I seem to remember that's been reported, too. My guess is children are easier to track, since T1 tends to develop quite suddenly so it's really clearly T1. Even so, if the numbers are similarly increased I presume someone will report on it.

 

[Sally71]

It’s well known that viruses can trigger type 1, isn’t it? Pretty sure it was a virus that did my daughter in. Therefore hardly surprising if the rate goes up when there has been a big pandemic.

Also, why does it say some can be attributed to backlogs and medical services being shut? If you are a child developing T1 you can’t wait for things to be open again, you’d be dead! You have to go straight to A&E whether it’s full of Covid cases or not…

 

[Bubbleblower]

The article cited in @Bruce Stephens 's post is talking about Type 1 diabetes (though it doesn’t make that clear in the title of the article, sloppy journalism again).

Yes, it says “Experts say it is unclear what has triggered the surge”, that’s why I said I am not an expert.

The prevalence of overweight and obesity among all children <18 was ~12% before the surge (here you can find all the actual numbers, which come from the Dutch Central Bureau of Statistics).

But the prevalence of overweight and obesity among type 1 diabetics <18 is 31,8%:

Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: Data from the international SWEET registry

 

[Bruce Stephens]

It’s well known that viruses can trigger type 1, isn’t it? Pretty sure it was a virus that did my daughter in. Therefore hardly surprising if the rate goes up when there has been a big pandemic.

That's what I'd assume, yes. And I'd assume children who don't seem to have been infected really have been (some just never produce antibodies). It feels a bit desperate to try and blame immunity dept (though lockdowns), especially since it's not clear that that is a thing.

Also, why does it say some can be attributed to backlogs and medical services being shut? If you are a child developing T1 you can’t wait for things to be open again, you’d be dead! You have to go straight to A&E whether it’s full of Covid cases or not…

Yes, also a bit of a stretch. I think in some children T1 can develop more slowly but I'm not sure how delaying diagnosis might help explain an increase in diagnoses.

 

[helli]

But the prevalence of overweight and obesity among type 1 diabetics <18 is 31,8%:

I am not aware of any correlation between Type 1 and obesity. The article you reference does not seem to mention whether this is a rise … or even if the data is available previously … and does not compare the numbers with children without Type 1.
As others have said, Type 1 is an autoimmune disease and the cause is not understood but there is evidence that trauma and/or viruses can trigger it. I have never seen any evidence that it is weight related apart from loss of weight being a common symptom.
I am only a sample of one but weight is definitely nothing to do with my diagnosis. I have never been over weight.

Regarding the relationship with covid, as an armchair amateur/speculator, I wonder if it has anything to do with covid attacking various organs including the pancreas. I even wonder if it is an autoimmune condition or more like Type 3c with organ damage by the virus causing the beta cells to stop working.

That said, I notice the incidents of Type 1 were rising before covid which I don’t believe is explained.

 

[Bubbleblower]

The article does not compare the numbers with children without Type 1.

Here are the numbers for all the children:

Numbers for Dutch or all* children are very simular, so the prevalence of OW or obesitas among type 1 diabetics (31,8%) is significantly higher than that among the whole population (11,95% in 2018).

I am only a sample of one but weight is definitely nothing to do with my diagnosis. I have never been over weight.

Same here.

I have never seen any evidence that it is weight related

No, but obviously it can be weight related.
The mechanisme is very simple; OW or obesitas causes ER stress which causes diabetes.

Just because Type 1 is a genetic disease doesn't mean it isn't an epigenetic disease as well.

 

[Robin]

Numbers for Dutch or Swedish children are very simular, so the prevalence of OW or obesitas among type 1 diabetics (31,8%) is significantly higher than that among the whole population (11,95% in 2018).

I’m getting a bit lost here, but doesn’t the SWEET study you cite refer to overweight and obesity levels in children who have already developed Type 1? We don’t know if they were overweight BEFORE diagnosis. Correlation is not causation. There are circumstances around treatment with insulin that might account for weight gain AFTER diagnosis, (too much insulin for example, leading to over eating to counter low blood sugars), we just don’t know, because this isn’t what the study set out to find.

No, but obviously it can be weight related

Why is it obvious? Have you seen any studies you can refer us to? The mainstream research into causes of Type 1 has always focussed on why the body produces antibodies that attack the beta cells, and as far as I'm aware, nobody has come up with a definitive answer.

 

[Bubbleblower]

I’m getting a bit lost here, but doesn’t the SWEET study you cite refer to overweight and obesity levels in children who have already developed Type 1? We don’t know if they were overweight BEFORE diagnosis.

Among adults there is little difference between type 1 diabetics and the whole population (60% vs 62%) so the difference is significant. Of course there is a chicken and egg problem, but surely not that big.

Why is it obvious? Have you seen any studies you can refer us to?

Well I figured it would be based on these articles.

The mainstream research into causes of Type 1 has always focussed on why the body produces antibodies that attack the beta cells, and as far as I'm aware, nobody has come up with a definitive answer.

Here is an interesting answer:

 

[helli]

@Bubbleblower please explain.
What has obesity got to do with increased number of children diagnosed with Type 1 diabetes during the covid pandemic?
Are you able to offer any evidence linking the diagnosis of Type 1 with obesity before, during and since the pandemic when one of the symptoms of untreated Type 1 is weight loss?

 

[Bubbleblower]

HRs for type 1 diabetes were 1.05 (95% CI 0.87, 1.27) for the 50th-74th BMI percentiles, 1.41 (95% CI 1.11, 1.78) for the 75th-84th BMI percentiles, 1.54 (95% CI 1.23, 1.94) for adolescents who were overweight (85th-94th percentiles), and 2.05 (95% CI 1.58, 2.66) for adolescents with obesity (≥95th percentile) (reference group: 5th-49th BMI percentiles). One increment in BMI SD was associated with a 25% greater risk for incidence of type 1 diabetes (HR 1.25, 95% CI 1.17, 1.32).

Obesity in late adolescence and incident type 1 diabetes in young adulthood​

 

[helli]

This is has no limk to covid (the data is from before the pandemic) and is for young adults not children

 

[Eddy Edson]

This is a small study. It has no pink to covid and is for young adults not children

Well, it wasn't a small study.

https://link.springer.com/content/pdf/10.1007/s00125-022-05722-5.pdf

Our final cohort included 1,426,362 adolescents who were followed continuously from the age of 17 years until the earliest date of diabetes onset, death, or 31 December 2016
It was for children/adolescents, longitudinally looking at which ones ended up with a T1D diagnosis in young adulthood.

It seems to report a pretty clear dose-dependent association:


Of course, this observational study can only reveal associations, not causation:

Finally, our study design cannot infer a causal relationship between
adolescent excessive BMI and incident type 1 diabetes.

But the authors pretty clearly think there is a causal relationship. As to possible mechanisms:

There is growing evidence of a link between obesity and
various autoimmune conditions [10, 28]. A possible explanation
is that the elevated levels of adipokines and cytokines
associated with obesity diminish self-tolerance by promoting
proinflammatory processes.

Additional factors associated
with obesity may contribute to the development of autoimmunity,
including vitamin D deficiency, consumption of a highfat
diet, and modulation of the gut microbiota.

Given that, in
our cohort, there was an association between obesity and type
1 diabetes even when excluding those with pre-existing autoimmune
conditions, additional factors may link obesity specifically
to type 1 diabetes. In fact, several biological mechanisms
have been suggested to explain the association between
obesity and type 1 diabetes.

The ‘accelerator hypothesis’ [29]
suggests that both type 1 and type 2 diabetes are caused by
insulin resistance set against various genetic backgrounds that
affect the rate of loss of beta cells and the disease phenotype.
According to this hypothesis, the increasing demand for insulin
renders the beta cells more antigenic, and thus accelerates
their loss through autoimmune injury.

High rates of insulin
production may be associated with accumulation of misfolded
proteins in insulin-producing cells, causing endoplasmic reticulum
stress [30]. To adapt to endoplasmic reticulum stress,
beta cells activate the unfolded protein response in order to
increase endoplasmic reticulum folding capacity, but this
signalling pathway also augments inflammation, attracting
immune cells and triggering the exposure of neo-antigens
[31].

No idea how plausible all that is! Or how good the study quality is, apart from being big.

 

[everydayupsanddowns]

Interesting associations, and not what I’d heard before. Clearly there‘s some way to go before any mechanisms behind this possible risk /association become clear.

Just hope it doesn’t add to the stigma experienced by many youngsters and families living with a T1 diagnosis, who often report frustration about uncaring comments regarding the reasons for diagnosis.

 

[Amity Island]

Some of the rise could be attributed to catch-up - from backlogs and delays when health services were shut - but does not explain all of the newly diagnosed cases, say scientists.​

Before the pandemic, the incidence rate of childhood type 1 diabetes was already increasing - by about 3% a year.​

The recent study found:​

• there was a 14% rise in the rate during the first year of the pandemic, compared to before Covid
• in the second year of Covid, the rate was up about 27% on pre-pandemic levels

Covid pandemic linked to surge in child and teen diabetes

Experts have seen a 'substantial' yet unexplained rise in new cases worldwide since the pandemic.

www.bbc.co.uk

My feelings on it are reduced vitamin D3, from reduced outdoor activity (sun exposure) from Lockdowns and the relentless fear campaigns. Probably the best thing one can do to prevent type 1 is a decent dose of vitamin D3. The further one lives from the equator, the higher the incidence of type 1 diabetes.