A recent report in Journal of the American Medical Association (JAMA) suggests that children who are at high risk for type-1 diabetes and have not yet shown symptoms may be more likely to develop the chronic disease after contracting Covid-19.
The findings indicate that the virus could potentially trigger an autoimmune response targeting the pancreas and causing damage to beta cells, ultimately leading to the onset of type-1 diabetes (T1D) in individuals who were not previously considered at risk.
Researchers in Germany conducted a study that followed 509 children from February 2015 to October 2023. The study focused on children between the ages of 1-16 with multiple islet autoantibodies. These proteins are known to attack and harm the cells in the pancreas that produce insulin, eventually leading to type-1 diabetes. Islet autoantibodies can be detected in the blood long before any symptoms of diabetes appear, making them powerful indicators of the likelihood of developing type-1 diabetes.
Before the pandemic, the diagnosis rate for diabetes in children was 6.4 cases per 100 children per year. This rate did not show a significant increase when the study participants were not infected with the Covid-19 virus. However, among the 236 children who did contract Covid-19, the rate of transitioning to a clinical diagnosis of diabetes more than doubled, reaching 14 cases per 100 children per year.
The researchers emphasised the need for additional studies to investigate whether Covid-19 hastens the development of type-1 diabetes in adults and whether individuals with presymptomatic T1D should be vaccinated and monitored for COVID-19 symptoms. This is particularly concerning for India, known as the diabetes capital of the world, where experts have reported a 40% rise in childhood diabetes cases in 2019 compared to the 1990s.
Concurring with the findings, Dr Amrita Ghosh, consultant at Fortis C-Doc Hospital in Delhi, said emerging research indicates a potential link between Covid-19 infection and an increased risk of developing type-1 diabetes, particularly in children and young adults.
Insulin production affected
High blood sugar, also known as diabetes, is often referred to as ‘silent killer’ because it can be asymptomatic in the early stages, or the symptoms may go unnoticed. This condition occurs when the body either cannot produce enough insulin or cannot utilise the insulin it produces effectively.
Unfortunately, there is no permanent cure for one of the most prevalent lifestyle diseases, which can potentially result in severe damage to vital organs, including the heart, blood vessels, eyes, kidneys, and nerves. While type-2 diabetes is the most common, and typically affects adults, experts in India are increasingly concerned about type-1 diabetes, earlier referred to as juvenile diabetes.
Insulin-dependent diabetes, also known as type-1 diabetes, is a chronic autoimmune disorder in which the pancreas produces little to no insulin. Insulin is a hormone that allows sugar (glucose) to enter the body’s cells for energy production. While T1D typically manifests in childhood or adolescence, it can also develop in adults.
Type-1 diabetes can be attributed to various factors, including genetics and certain viruses. According to the Indian Council of Medical Research (ICMR), in 2022, about 95,600 children under the age of 14 in India are affected by T1D.
Rise in cases among kids
“Studies suggest that Covid-19 may act as a viral trigger for autoimmune responses, leading to the destruction of insulin-producing cells in genetically predisposed individuals. An increase in new-onset type-1 diabetes cases has been observed post-infection, raising concerns about the long-term impact of Covid-19 on autoimmune conditions,” he said.
According to Dr Dheeraj Kapoor, chief of endocrinology at Artemis Hospitals in Gurgaon, researches around the world have raised concerns about a notable increase in the risk of T1D in children following Covid-19 infection.
The JAMA findings indicate that children who have had Covid-19 are 16% more likely to develop type-1 diabetes within six months to a year after the infection, compared to levels before the pandemic. “This worrying connection is expected due to the virus’s autoimmune response, which could potentially harm the insulin-producing cells in the pancreas,” he added. Dr Aasim Maldar, consultant, endocrinologist and diabetologist, PD Hinduja Hospital and Medical Research Centre in Mumbai, has noted a gradual increase in the incidence of diabetes among children in India. He mentioned that it’s challenging to determine whether there has been a rise in the absolute number of children with new diagnoses of type-1 diabetes after the Covid-19 pandemic, as there is no published study in India on the matter. However, he pointed out several possible reasons for the increasing number of type-1 diabetes cases.
“Analysis of large healthcare service data sets from many western countries has shown a substantial increase in type-1 diabetes after the Covid-19 pandemic. There could be a direct effect of SARS-CoV2 virus on the development of type-1 diabetes (like enteroviruses, cytomegalovirus, and rubella virus have previously shown to be associated with the development of T1D),” he said.
Dr Maldar also mentioned that SARS-Cov2 infection could potentially change the composition of microorganisms in our stomachs and intestines, known as the ‘gut microbiome’. This shift may lead to an increase in unfavourable organisms at the expense of beneficial ones. The alteration in the microbiome has been linked to the development of various chronic conditions, such as diabetes, obesity, and heart diseases.
Lack of exposure to antigens
The increase in diabetes diagnoses may also be due to a surge in catching up on missed diagnoses during the COVID-19 pandemic. As attention shifts to chronic diseases, more people seek medical advice for non-urgent symptoms unrelated to respiratory issues.
“Exposure to common infections in childhood has shown to be protective against auto-immune diseases like type-1 diabetes, and this shielding may render children more susceptible to autoimmune diseases,” he said, adding that during the pandemic parents adapted a highly protective environment for their children, which prevented them from getting exposed to various antigens or factors which actually help boost immunity.
Dr V Mohan, chairman of the Madras Diabetes Research Foundation (MDRF), said that while numerous articles and research studies have indicated a rise in childhood T1D during the Cocid-19 pandemic, the exact reason for this increase is unknown.
“Initial studies suggested that there could be a direct effect of the Covid-19 on pancreatic beta cell producing damage. However, despite many studies being done and several postmortem examinations also being conducted in children who unfortunately died due to Covid-19 infection, direct demonstration of the presence of the virus inside the pancreatic beta cells have been shown only in a couple of cases. It appears that the direct toxicity of the virus affecting the pancreatic beta cells and causing diabetes would be a rather uncommon cause of T1D,” Dr Mohan said.
It is also possible that the stress stemming from the Covid-19 pandemic, the effects of the lockdown, the potential increase in obesity, and reduced physical activity may have also served as triggers, he added.
Stay vigilant
Currently there is no cure for this condition, although some innovative experimental treatments are being explored. The focus is to effectively manage blood sugar levels through insulin, dietary adjustments, and lifestyle changes to prevent potential complications. Dr Ghosh recommends close monitoring of individuals, particularly children, who have recovered from Covid-19.
Given the global rise in pediatric Covid-19 cases, Dr Kapoor said early detection and intervention are crucial in managing T1D. “The potential increase in T1D cases emphasises the need for continued vigilance and possibly even revised guidelines for post-covid care in pediatric patients,” he added.
Dr Maldar emphasised the importance of regular health check-ups, staying vigilant for any symptoms, promptly seeking advice from a family doctor for any health concerns, maintaining a nutritious diet and healthy lifestyle, engaging in regular exercise, managing weight, and effectively dealing with stress as crucial preventive measures for individuals.