Risk of Type 1 Diabetes in Children is Not Increased after SARS-CoV-2 Infection: A Nationwide Prospective Study in Denmark

Structured AbstractO_ST_ABSObjectiveC_ST_ABSIt has been hypothesized that SARS-CoV-2 infection in children can increase risk of developing type 1 diabetes. Research Design and MethodsWe undertook a prospective analysis based on all children in Denmark where we investigated the association between SARS-CoV-2 infection and subsequent risk of type 1 diabetes, using information from several different national Danish registers. Denmark had one of the highest test-rates per capita in the world during the pandemic. ResultsWe did not observe a higher risk of a first time diagnosis of type 1 diabetes in children 30 days or more after a positive SARS-CoV-2 test, compared to children with a history of only negative SARS-CoV-2 tests (Hazard ratio 0.85, 95% CI 0.70, 1.04). ConclusionsOur data do not support that SARS-CoV-2 infection is associated with type 1 diabetes, or that type 1 diabetes should be a special focus after a SARS-CoV-2 infection in children. Article HighlightsO_ST_ABSWhy did we undertake this study?C_ST_ABSO_LIStudies have shown an association between SARS-CoV-2 infection and subsequent risk of type 1 diabetes, supporting the possibility of a viral etiology in type 1 diabetes and adding to concerns regarding adverse health consequences of COVID-19. C_LI What is the specific question(s) we wanted to answer?O_LIIs the risk of new onset type 1 diabetes increased among children in the period after SARS-CoV-2 infection? C_LI What did we find?O_LIWe estimated the relative risk of being diagnosed with type 1 diabetes after a positive compared to a negative SARS-CoV-2 test, to 0.85 (95% CI 0.70, 1.04). C_LI What are the implications of our findings?O_LIOur data do not support an association between SARS-CoV-2 infection and subsequent risk of type 1 diabetes among children. C_LI Twitter SummaryA study based on all children in Denmark does not show any association between #SarsCoV2 infection and subsequent risk of #Type1Diabetes among persons < 18 years. #Type1Diabetes should not be a special focus after a #SarsCoV2 infection in children.

Inhaled corticosteroid use in COVID-19

BackgroundRecent evidence has established a beneficial effect of systemic corticosteroids for treatment of moderate-to-severe COVID-19. However, it is unknown if inhaled corticosteroid use is associated with reduced morbidity of the disease. MethodsIn a nationwide cohort of hospitalized SARS-CoV-2 test-positive individuals in Denmark, we estimated the 30-day hazard ratio of intensive care unit (ICU) admission or death among users of inhaled corticosteroids (ICS) compared with users of non-ICS inhalers ({beta}2-agonist/muscarinic-antagonists), or non-users of ICS, with Cox regression adjusted for age, sex, and other confounders. We repeated these analyses among influenza test-positive patients during 2010-2018. ResultsAmong 2,180 hospitalized SARS-CoV-2 patients, 282 were admitted to ICU and 421 died within 30 days. ICS use was associated with a hazard ratio of 1.25 (95% CI [CI], 0.60 to 2.61) for ICU admission and 0.84 (95% CI, 0.54 to 1.31) for death compared with non-ICS inhaler use. Compared with no ICS use, the hazard ratio of ICU admission or death was 1.22 (95% CI, 0.77 to 1.94) and 1.05 (95% CI, 0.75 to 1.47), respectively. Among 10,279 hospitalized influenza patients, the hazard ratios were 1.43 (95% CI, 0.89 to 2.30) and 1.11 (95% CI, 0.85 to 1.46) for ICU admission, and 0.80 (95% CI, 0.63 to 1.01) and 1.03 (95% CI, 0.87 to 1.22) for death compared with non-ICS inhaler use and no ICS use, respectively. ConclusionsOur results do not support an effect of inhaled corticosteroid use on COVID-19 morbidity, however we can only rule out moderate-to-large reduced or increased risks.