Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years - United States, March 1, 2020-June 28, 2021

Abstract

The COVID-19 pandemic has disproportionately affected people with diabetes, who are at increased risk of severe COVID-19.* Increases in the number of type 1 diabetes diagnoses (1,2) and increased frequency and severity of diabetic ketoacidosis (DKA) at the time of diabetes diagnosis (3) have been reported in European pediatric populations during the COVID-19 pandemic. In adults, diabetes might be a long-term consequence of SARS-CoV-2 infection (4-7). To evaluate the risk for any new diabetes diagnosis (type 1, type 2, or other diabetes) >30 days^† after acute infection with SARS-CoV-2 (the virus that causes COVID-19), CDC estimated diabetes incidence among patients aged <18 years (patients) with diagnosed COVID-19 from retrospective cohorts constructed using IQVIA health care claims data from March 1, 2020, through February 26, 2021, and compared it with incidence among patients matched by age and sex 1) who did not receive a COVID-19 diagnosis during the pandemic, or 2) who received a prepandemic non-COVID-19 acute respiratory infection (ARI) diagnosis. Analyses were replicated using a second data source (HealthVerity; March 1, 2020-June 28, 2021) that included patients who had any health care encounter possibly related to COVID-19. Among these patients, diabetes incidence was significantly higher among those with COVID-19 than among those 1) without COVID-19 in both databases (IQVIA: hazard ratio [HR] = 2.66, 95% CI = 1.98-3.56; HealthVerity: HR = 1.31, 95% CI = 1.20-1.44) and 2) with non-COVID-19 ARI in the prepandemic period (IQVIA, HR = 2.16, 95% CI = 1.64-2.86). The observed increased risk for diabetes among persons aged <18 years who had COVID-19 highlights the importance of COVID-19 prevention strategies, including vaccination, for all eligible persons in this age group,^§ in addition to chronic disease prevention and management. The mechanism of how SARS-CoV-2 might lead to incident diabetes is likely complex and could differ by type 1 and type 2 diabetes. Monitoring for long-term consequences, including signs of new diabetes, following SARS-CoV-2 infection is important in this age group.

FIGURE

Hazard ratio for the association between COVID-19 or acute respiratory infection and new diabetes diagnosis among patients aged <18 years, by age group and sex — IQVIA PharMetrics Plus and HealthVerity claims databases, United States, March 1, 2020–June 28, 2021^,, Abbreviations: ARI = acute respiratory infection; HR = hazard ratio, ICD-10-CM = International Classification of Diseases, Tenth Revision, Clinical Modification; Ref = referent. https://www.iqvia.com/; https://healthverity.com/ ^† 95% CIs indicated by error bars. ^§ Groups in IQVIA included patients aged <18 years with or without COVID-19 (COVID-19; non–COVID-19, respectively) and patients aged <18 years with or without ARI (ARI; non-ARI, respectively), during March 1, 2020–February 26, 2021, determined using presence or absence of ICD-10-CM codes for COVID-19 and ARI. The non–COVID-19 group was matched 5:1 to the COVID-19 group by age, sex, and month of encounter. The ARI group was matched 5:1 to the COVID-19 group by age and sex, and a random encounter date was selected. The non-ARI group was matched 2:1 to the ARI group by age and sex, and a random encounter date was selected. In HealthVerity, among patients aged <18 years, those with COVID-19 (COVID), determined by ICD-10-CM code or by a positive SARS-CoV-2 test result during March 1, 2020–June 28, 2021, were matched 1:1 to those with a negative SARS-CoV-2 test result (non–COVID-19) during the same period by age, sex, and month of encounter. ^¶ Hazard ratios are plotted on a logarithmic scale.