Prevalence of SARS-CoV-2 Antibodies in Children and Adults with Type 1 Diabetes

Abstract

Objective: As diabetes is a risk factor for severe symptoms, hospitalization, and death with COVID-19 disease, we aimed to assess the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in children and adults with and without type 1 diabetes in Colorado during 2020. Research Design and Methods: We developed a highly sensitive and specific test for antibodies against SARS-CoV-2 and measured the antibodies in children and adults with new-onset (n = 129) and established type 1 diabetes (n = 94) seen for routine diabetes care at our center between January and October 2020. The antibodies were also measured in 562 children and 102 adults from the general population of Colorado. Results: The prevalence of SARS-CoV-2 antibodies in persons with new-onset type 1 diabetes (0.8%; 95% confidence interval 0.1%-4.2%) or those with established disease (4.3%; 1.7%-10.4%) did not differ from that in the general population children (2.8%; 1.8%-4.6%) or adults (3.9%; 1.5%-9.7%). In a subset of individuals with positive antibodies (n = 31), antibodies remained positive for up to 9 months, although the levels decreased starting 3 months after the infection (P = 0.007). Conclusions: From January to October 2020, the prevalence of SARS-CoV-2 antibodies were not different in children and adults with and without type 1 diabetes in Colorado. We found no evidence for increased prevalence of COVID-19 infections among youth with newly diagnosed type 1 diabetes. (COMIRB Protocol 20-1007).

Keywords: Antibodies; COVID-19; New-onset; Type 1 diabetes.

FIG. 1.

COVID-19 antibody ECL test. (A) Assay diagram that uses fluid-phase binding of antibody in serum to two labeled RBD proteins. The SULFO-TAG-labeled RBD protein emits ECL when stimulated. (B) Results of validation testing with SARS-CoV-2 PCR+ convalescent sera (n = 58), SARS-CoV-2 PCR- but with other viral infections confirmed by PCR (n = 7), and pre-COVID-19 samples (n = 922). The mean value from duplicate wells are plotted for each sample and box plots showed the minimum, maximum, median, and 25th and 75th percentiles for each group. Dotted line at an index of 5 is the cutoff for positivity. ECL, electrochemiluminescence; PCR, polymerase chain reaction; RBD, receptor-binding domain; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Color images are available online.

FIG. 2.

COVID-19 antibody levels over time. Repeat testing of COVID-19 antibodies in 31 positive subjects. X-axis represents follow-up time in month since COVID-19 infection. An index of 5 is the cutoff for positivity. The antibody levels (index) were Box–Cox transformed to normalize the data. The levels increased during the initial 3 months after infection (P = 0.029) and decreased thereafter (P = 0.007).