Previous SARS-CoV-2 Infection Is Not Associated With Increased Celiac Disease Autoimmunity in Children and Adolescents.

INTRODUCTION: Recent reports suggest severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections may increase the risk of celiac disease autoimmunity. This study aims to evaluate potential associations between coronavirus disease 2019 infection and tissue transglutaminase autoantibodies (TGA) immunoglobulin A. METHODS: From 2020 to 2021, cross-sectional screening for SARS-CoV-2 antibodies and TGA was offered to 4,717 children in Colorado through the Autoimmunity Screening for Kids study. Multivariable logistic regression assessed association between previous SARS-CoV-2 infection and TGA positivity. RESULTS: Previous SARS-CoV-2 infection was not associated with TGA positivity (odds ratio 1.02, 95% confidence interval 0.63-1.59; P = 0.95). DISCUSSION: In this large-scale analysis, previous SARS-CoV-2 infection was not associated with celiac disease autoimmunity in Colorado children.

Similar Time Course of Humoral Response to SARS-CoV-2 mRNA Vaccines in People With and Without Type 1 Diabetes.

Objective: To assess whether the immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines or breakthrough infection rates differ between patients with type 1 diabetes (T1D) and control subjects. Research Design and Methods: A prospective 12-month follow-up of 27 adults with T1D and 89 control subjects who received at least two doses of either the mRNA-1273 or BNT162b2 vaccine. Primary outcomes: total antibodies against the receptor-binding domain and neutralizing antibodies. A multivariate repeated measures model evaluated potential determinants of antibody response. Results: Neither antibody levels nor breakthrough infection rates after vaccination differed in T1D and non-T1D groups. Older age predicted lower antibody levels, whereas SARS-CoV-2 infection or booster vaccine resulted in higher antibody levels in both groups. mRNA-1273 was associated with higher antibody levels than BNT162b2 until 6 months after the first dose. Conclusions: Persons with and without T1D have similar humoral antibody responses to SARS-CoV-2 mRNA vaccines during 12-months of follow-up.

SARS-CoV-2 Infections and Presymptomatic Type 1 Diabetes Autoimmunity in Children and Adolescents From Colorado, USA, and Bavaria, Germany.

This study screens more than 50 000 youths in diverse populations of Colorado and Bavaria to assess whether previous SARS-CoV-2 infection was associated with autoimmunity, which predicts future type 1 diabetes.

The Coronavirus Disease 2019 Pandemic is Associated with a Substantial Rise in Frequency and Severity of Presentation of Youth-Onset Type 2 Diabetes.

OBJECTIVES: To evaluate the frequency and severity of new cases of youth-onset type 2 diabetes in the US during the first year of the pandemic compared with the mean of the previous 2 years. STUDY DESIGN: Multicenter (n = 24 centers), hospital-based, retrospective chart review. Youth aged ≤21 years with newly diagnosed type 2 diabetes between March 2018 and February 2021, body mass index ≥85th percentile, and negative pancreatic autoantibodies were included. Demographic and clinical data, including case numbers and frequency of metabolic decompensation, were compared between groups. RESULTS: A total of 3113 youth (mean [SD] 14.4 [2.4] years, 50.5% female, 40.4% Hispanic, 32.7% Black, 14.5% non-Hispanic White) were assessed. New cases of type 2 diabetes increased by 77.2% in the year during the pandemic (n = 1463) compared with the mean of the previous 2 years, 2019 (n = 886) and 2018 (n = 765). The likelihood of presenting with metabolic decompensation and severe diabetic ketoacidosis also increased significantly during the pandemic. CONCLUSIONS: The burden of newly diagnosed youth-onset type 2 diabetes increased significantly during the coronavirus disease 2019 pandemic, resulting in enormous strain on pediatric diabetes health care providers, patients, and families. Whether the increase was caused by coronavirus disease 2019 infection, or just associated with environmental changes and stressors during the pandemic is unclear. Further studies are needed to determine whether this rise is limited to the US and whether it will persist over time.

Effects of the COVID-19 Pandemic on Type 1 Diabetes Outcomes

As the COVID-19 pandemic has disrupted daily life, it is important to understand its effects on youth with T1D. The COVID-19 Exposure and Family Impact Survey (CEFIS) was used to examine COVID-19 effects on diabetes metrics in a pediatric T1D population. Parents of youth with T1D (n=108;mean age 11.6±4 yrs, mean T1D duration 5.3±3.9yrs, 57.4% male) completed the CEFIS (score ranges: Exposure 0-25, Impact 0-4 with >2.5 indicating negative impact, and Distress 1-10) . CEFIS measures and diabetes metrics (A1c, average glucose, in-person visits vs. telemedicine, and number of cancelled visits) were obtained at baseline, 3, 6, 9, and 12 months. Changes in diabetes metrics and correlations with CEFIS scores were analyzed by anova. Cancelled visit frequency per person decreased from baseline to 3 months and was maintained for the duration of the study (p<0.001) . For every one point increase in CEFIS Impact, A1c increased by 0.3 (0.1%) (p=0.04) . For every one point increase in CEFIS Exposure, average glucose increased by 2.3 (0.7mg/dL) (p=0.002) . High perceived stress from the COVID-19 pandemic from CEFIS Impact and Exposure scores may worsen glycemic outcomes for youth, suggesting that the pandemic had a negative affect regardless of COVID-19 infection. Further studies on perceived stress and effects on diabetes management are needed to determine long term impacts of the COVID-19 pandemic on this population.

Impact of the COVID-19 Pandemic on Quality of Life in Youth with Type 1 Diabetes

Diabetes is a risk factor for COVID-19 infection-related complications, increasing fear in this population. The effect of the pandemic on quality of life for youth with type 1 diabetes (T1D) has not been evaluated. Youth with T1D (n=108, mean age 11.6±4.0 yrs, mean T1D duration 5.3±3.9, 57.4% male) and a parent completed surveys at baseline (September to November 2020) and every 3 months for 12 months. Measures included the COVID-19 Exposure and Family Impact Survey ([CEFIS], exposure (range 0-25) , family impact (range 0-4, scores >2.5 indicate negative impact) , distress (range 1-10)) , the PedsQL Diabetes Module (higher score indicates higher quality of life) , and the PROMIS Sleep Disturbance and Sleep-Related Impairment surveys (higher score indicates more problems) . CEFIS impact score remained above 2.5 over 12 months. Parent Proxy PedsQL decreased from 3 to 6 months (p=0.019) and 3 to 12 months (p=0.017) . Parent Proxy PROMIS Sleep-Related Impairment increased from 6 to 12 months (p=0.03) and 9 to 12 months (p=0.004) . PedsQL (parent and child) significantly decreased with increased exposure (p<0.001 and p=0.011) and impact (p<0.001 and p=0.016) . Families of youth with T1D were negatively impacted by the pandemic. Parents reported worsening child quality of life and sleep-related impairment during this time. As the pandemic continues, it is important for health care providers to be mindful of mental health in youth with T1D.

SARS-CoV-2 Infection Is Not Associated with Presence of Islet Autoantibodies in Children: Autoimmunity Screening for Kids (ASK)

Viral infections may trigger islet autoimmunity leading to type 1 diabetes (T1D) . We hypothesized SARS-CoV-2 infection is associated with presence of islet autoantibodies (IAb) in children. Between 8/2020 and 12/2021, ASK screened 47general population Colorado children aged 1-17 y for IAb to GAD, insulin, IA-2 and ZnT8 as well as antibodies to SARS-CoV-2 receptor binding domain (CoV-2 RBDAb) - a sensitive and specific marker of infection. Of those, 4172 (89%) have not previously received SARS-CoV-2 vaccine. During the study period, prevalence of CoV-2 RBDAb increased in unvaccinated from 1% to 58% and up to 100% among vaccinated. Among all children, the prevalence increased from 1% to 72% - an estimate of herd immunity (Figure) . Among the unvaccinated, prevalence of multiple or single high-affinity IAb did not differ between children positive vs. negative for CoV-2 RBDAb, respectively 1.23% (16/1297) vs. 1.00% (29/2875) , p=0.52. In multivariate logistic regression, presence of IAb was not associated with presence of CoV-2 RBDAb (OR=1.40, p=0.31) , adjusting for age, sex, race/ethnicity, and family history of T1D. While we found no association between past SARS-CoV-2 infection and islet autoimmunity, a confirmation in a larger population is warranted. Longer follow-up will help assess whether SARS-CoV2 infection accelerates progression from islet autoimmunity to diabetes.

Diabetes Technology Use in Remote Pediatric Patients with Type 1 Diabetes Using Clinic-to-Clinic Telemedicine.

Background: Clinic-to-clinic telemedicine can increase visit frequency in pediatric patients with type 1 diabetes (T1D) living far from a diabetes specialty clinic, but the impact on adoption of diabetes technology is unclear. Materials and Methods: Pediatric patients with T1D in Colorado and surrounding states who received diabetes care using clinic-to-clinic telemedicine were enrolled. Medical records and surveys were reviewed to ascertain technology use, and data were compared to patients from the main clinic population. Results: Patients (N = 128, baseline mean age 12.4 ± 4.2 years, median T1D duration 3.3 years [IQR 1.4-7.7], mean A1c 8.9% ± 1.8%, 60% male, 75% non-Hispanic white, 77% private insurance) who utilized telemedicine were included. Technology use among telemedicine patients was not associated with gender, T1D duration, insurance, distance from the main clinic or rural designation but was associated with ethnicity and A1c. Compared to the main clinic cohort (N = 3636), continuous glucose monitor (CGM) use and pump/CGM combination use was lower among patients participating in clinic-to-clinic telemedicine (CGM: 29.7% vs. 56.0%, P < 0.001; CGM/pump combination: 27.3% vs. 40.3%, P = 0.004). Technology use was associated with lower A1c regardless of cohort. Conclusions: Compared to patients attending in-person clinic, pediatric T1D patients who use clinic-to-clinic telemedicine due to their distance from the main clinic, have lower CGM and combination CGM/pump use. For both telemedicine and main clinic patients, CGM and CGM/pump combination was associated with lower A1c. Additional research is needed to explore reasons for this discrepancy and find methods to improve CGM use in this population.

Family Exposure and Impact of COVID-19 on a Pediatric T1D Population

The COVID-19 pandemic resulted in unprecedented changes in day-to-day life. In families of youth with type 1 diabetes (T1D), preliminary studies suggest impacts on physical/mental health and diabetes self-management. The COVID-19 Exposure and Family Impact Survey (CEFIS) assesses the impact of the pandemic. Parents of youth with T1D (mean age 11.6 yrs, mean T1D duration 5.3 yrs, 57.4% male) completed the CEFIS. Outcomes include exposure (range 0-25), family impact (range 0-4, scores >2.5 indicate negative impact), and distress (range 1-10). Data were collected at baseline (Sept to Nov 2020) and 3-month follow-up (Dec 2020 to Feb 2021). Exposure scores were relatively low (baseline 7.63±2.56, 3-months 7.50±2.93), however, a negative impact on families was reported at baseline (2.74±0.57) and 3-months (2.71±0.60). Distress was present at baseline and 3-months (range 4.26±2.03 to 4.86±2.05). There were no significant group differences when stratifying baseline scores by age or T1D duration. Despite relatively low exposure, COVID-19 had a negative impact on families of youth with T1D. Similar family impact and distress scores at baseline and 3-months highlight the enduring impact of the pandemic on families almost a year into the pandemic. Additional information is needed on how COVID-19 has impacted T1D management. However, clinicians need to be mindful of the significant distress families may be experiencing as a result of the pandemic.