Incidence of an Insulin-Requiring Hyperglycemic Syndrome in SARS-CoV-2–Infected Young Individuals: Is It Type 1 Diabetes?

Abstract

Pancreatic ACE2 receptor expression, together with increased prevalence of insulin-requiring hyperglycemia in patients with coronavirus disease 2019 (COVID-19), suggested that severe acute respiratory syndrome coro-navirus 2 (SARS-CoV-2) pancreatic infection might trigger a b-cell–selective inflammation precipitating autoim-mune type 1 diabetes (T1D). We examined T1D incidence in patients with COVID-19 inside a large, global population using a “big data” approach. The incidence in 0–30-year-old patients with confirmed COVID-19 over an ~15-month period from the beginning of the COVID-19 pandemic was compared with an age-matched population without COVID-19 inside the Tri-NetX COVID-19 Research Network (>80 million deiden-tified patient electronic medical records globally). The cohorts were used to generate outcomes of T1D post-index. In those up to 18 years of age, the incidence of insulin-requiring diabetes that could represent T1D in patients with already diagnosed, confirmed COVID-19 was statistically indistinguishable from the control population without COVID-19. In contrast, in those aged 19–30 years, the incidence was statistically greater. These data suggest that the incidence of T1D among patients with COVID-19 <30 years of age, at least up to this time since the beginning of the pandemic, is not greater when compared with an age-, sex-, and BMI-matched population without COVID-19. Nevertheless, we caution that patients with COVID-19 could be asymptomatic of a diabetic/pre-diabetic state and therefore would not be expected to come to medical attention, remaining undiagnosed. Hence, it is still possible that asymptomatic virus-infected individuals could acquire b-cell autoimmunity, eventually progressing to dysglycemia and clinical T1D at higher rates.