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. 2025 Sep;42(9):e70084.
doi: 10.1111/dme.70084. Epub 2025 Jun 17.

SARS-CoV-2 infection and new-onset type 1 diabetes in the post-acute period among children and young people in England

Joseph L Ward  1   2 , Joana Cruz  2 , Rachel Harwood  3 , Simon Kenny  3   4 , Dougal Hargreaves  5 , Kamlesh Khunti  6 , Jonathan Valabhji  4   7 , Bianca De Stavola  2 , Russell M Viner  2
Affiliations

SARS-CoV-2 infection and new-onset type 1 diabetes in the post-acute period among children and young people in England

Joseph L Ward et al. Diabet Med. 2025 Sep.

Abstract

Aims: To examine if SARS-CoV-2 infection is associated with new-onset type 1 diabetes in the post-acute period in children and young people (CYP).

Methods: In this population cohort, we used data on all hospital activity in England to estimate type 1 diabetes incidence among CYP aged 0-17 exposed to SARS-CoV-2 between May 2020 and August 2022, from day 28 after a positive test for the following 6 months. We compared this with unexposed CYP who were hospitalized for elective procedures or following trauma during the pandemic, and in the 2 years prior to the pandemic (historic cohorts). We excluded CYP with prior chronic illnesses. We undertook Cox regression analyses adjusted for age, sex, ethnicity, deprivation and season of index date, and stratified by periods when different SARS-CoV-2 variants were dominant.

Results: There were 1,087,604 CYP in the exposed cohort, 143,748 in the trauma cohort, 253,368 in the elective cohort, 160,925 in the historic trauma cohort and 388,673 in the historic elective cohort. Hazard of developing type 1 diabetes was significantly higher among those exposed than unexposed CYP: 2.4 [1.58-3.64] relative to the trauma cohort, 2.9 [2.00-4.13] relative to the elective cohort, 4.2 [2.56-7.04] relative to the historic trauma cohort and 2.4 [1.81-3.10] relative to the historic elective cohort. Associations may be strongest during the Delta period.

Conclusions: SARS-CoV-2 infection is associated with subsequent incident type 1 diabetes in the 1-7 months after an acute infection in previously healthy CYP.

Keywords: SARS‐CoV‐2; children and young people; epidemiology; population cohort; type 1 diabetes.

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Conflict of interest statement

KK has acted as a consultant, speaker or received grants for investigator‐initiated studies for Astra Zeneca, Bayer, Novartis, Novo Nordisk, Sanofi‐Aventis, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Oramed Pharmaceuticals, Pfizer, Roche, Daiichi‐Sankyo and Applied Therapeutics. KK was chair of the ethnicity subgroup of the UK Scientific Advisory Group for Emergencies (SAGE) and a member of SAGE. JV was the National Clinical Director for Diabetes and Obesity at NHS England from April 2013 to September 2023.

Figures

FIGURE 1
FIGURE 1
Incidence rate of new‐onset type 1 diabetes from Day 28 to Day 208 of follow‐up per 100,000 person‐years of observation. Incident rate ratios per 100,000 for being diagnosed with T1DM from Day 28 to Day 208 amongst each cohort. Exposed: CYP testing positive for SARS‐CoV‐2; unexposed traumatic: CYP admitted due to trauma 1 May 2020–31 August 2022 and not testing positive for SARS‐CoV‐2; unexposed elective: CYP admitted electively 1 May 2020–31 August 2022 and not testing positive for SARS‐CoV‐2; unexposed elective traumatic: CYP admitted due to trauma 1 January 2018–1 January 2020; unexposed elective historic: CYP admitted electively 1 January 2018–1 January 2020.
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