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

posted on 16.03.2022, 15:30 by Massimo Pietropaolo, Peter Hotez, Nick Giannoukakis
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.


We are greatly thankful to the McNair Medical Institute at The Robert and Janice McNair Foundation for supporting our research on Type 1 diabetes (to Massimo Pietropaolo).