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

Pancreatic Angiotensin Converting Enzyme 2 receptor (ACE2) expression, together with increased prevalence of insulin-requiring hyperglycemia in COVID-19 patients, suggested that SARS CoV-2 pancreatic infection might trigger a beta cell-selective inflammation precipitating autoimmune type 1 diabetes (T1D). We examined T1D incidence in COVID-19 patients inside a large, global population using a “big data” approach. The incidence in 0-30 year-old confirmed COVID-19 patients over an approximately 15 month period from the beginning of the COVID-19 pandemic was compared to an age-matched non-COVID-19 population inside the TriNetX COVID-19 Research Network (>80 million de-identified patient electronic medical records globally). The cohorts were used to generate outcomes of T1D post-index. In ages up to 18, the incidence of insulin-requiring diabetes that could represent T1D in patients with already-diagnosed, confirmed COVID-19 was statistically-indistinguishable from the non-COVID-19 control population. In contrast, in ages 19-30, the incidence was statistically-greater. These data suggest that the incidence of T1D among COVID-19 patients <30 years of age, at least up to this time since the beginning of the pandemic, is not greater when compared to a non-COVID-19 age, sex, and BMI-matched population. Nevertheless, we caution that COVID-19 patients 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 beta cell autoimmunity, eventually progressing to dysglycemia and clinical T1D at higher rates.