Acceleration of type 1 diabetes onset during the COVID-19 pandemic.

Background: Studies since the beginning of the COVID-19 pandemic suggest an increase in new cases of type 1 diabetes (T1D) but the etiology of this increase remains unclear. Objective: To examine whether there was a change in yearly proportions of newly diagnosed T1D by a single-center tertiary pediatric endocrinology practice in the post-pandemic era in comparison to pre-pandemic, T1D presenting characteristics, and the relationship of T1D antibodies both in those diagnosed before the pandemic versus those diagnosed after and those with COVID-19 versus other or no known respiratory viral illnesses. Methods: The study consisted of a retrospective chart review of children diagnosed with T1D between January 2018 and May 2022, stratifying them into cohorts based on respiratory infection status: known COVID-19 respiratory infection (COVID), other upper respiratory infection (URI), and no known viral respiratory infection (NONE). There was comparison of autoantibody positivity (type, number, and titer) between cohorts using non-parametric tests and descriptive statistics. Results: A total of 351 patients were included (mean age 9.8 ± 4.2 years; 59.4% male; 48.4% White, 18.2% African American, 8.3% Asian, 15.4% Hispanic/Latino, 24.8% other). At diagnosis, mean hemoglobin A1c (HbA1c) was 11.5 ± 2.3%. Overall T1D rates did not differ significantly between pre-pandemic (n=162, 46%) and post-pandemic (n=189, 54%) eras but new cases fluctuated significantly by year ( Conclusions: These findings suggest that the COVID-19 pandemic may have accelerated disease progression in predisposed individuals rather than inducing T1D through COVID-19-mediated autoimmunity.