Can coronavirus trigger type 1 diabetes?

This came from new research, published in Diabetes Care, which looked at the number of children newly diagnosed with type 1 diabetes in five hospitals in North West London during the coronavirus pandemic and compared this with typical rates seen over the past five years.

What the coronavirus research tells us

In total, 30 children were diagnosed with type 1 diabetes between 23 March and 4 June 2020 in the area the researchers looked at. Most of these cases were clustered in two hospitals, where 20 children were diagnosed. Based on typical prior years, during the same period these hospitals would only expect to see around six cases. However, in the other three hospitals there was no increase observed – the number of children diagnosed with type 1 diabetes was similar to previous years.

When they investigated further, the researchers found some of the newly diagnosed children had been exposed to coronavirus. Of the 30 children with new-onset type 1 diabetes, 21 were tested for current or past coronavirus infection. Five children were found to have coronavirus or have antibodies indicating they’d already had the virus. From this, the researchers suggest coronavirus could potentially be playing a role in the higher rates of type 1 diabetes seen in some of their hospitals. But this research can’t make a definitive link between the two.

The researchers also observed high rates of diabetic ketoacidosis (DKA) in children who were diagnosed during the pandemic, but again we can’t tell from this study whether this is down to coronavirus.

What the research doesn’t tell us

These observations build on reports that came through early on in the pandemic, when doctors flagged concerns around new cases of both type 1 and type 2 diabetes in people with coronavirus.

But we need to keep in mind that all the evidence so far pointing to a possible link is based on anecdotal reports and observations from a tiny handful of people. It’s still very early days in our understanding of the effects of coronavirus and although this study raises an important question – one that we need to keep an eye on – it does not prove that coronavirus can trigger type 1 diabetes in children.

It’s unclear what’s behind the apparent rise of type 1 cases in this study and we simply don’t have the evidence yet to point the finger at coronavirus. This study was also limited to one small area in North West London. We don’t know whether we’d see similar increases in new-onset type 1 diabetes if we looked more widely across the UK.

This research also can’t tell us anything about why coronavirus could be driving new incidences of type 1 diabetes. The causes of type 1 diabetes are complex and scientists think that there are likely to be a variety of environmental and genetic reasons for why the condition develops. Viruses have long been thought to be one likely culprit.

When thinking about coronavirus, we know it uses a protein called ACE2 to take hold. The coronavirus locks on to ACE2 and uses it as its doorway to enter and infect cells. We make ACE2 in our pancreas and it’s possible when binding to ACE2 here, the virus could damage insulin-producing beta cells. This could either push people who are already at high risk of type 1 diabetes towards a diagnosis, or it could perhaps give rise to a new type of diabetes.

For now we don’t have any answers but scientists are working on it. An international group of top diabetes researchers are building a database of new cases of diabetes in people with coronavirus, called the CoviDiab registry. This will give them the information they need to carry out more thorough studies and work out what’s really going on. 

The 4 Ts of type 1 diabetes

Although at the moment there is no strong evidence to be able to make any firm conclusions about coronavirus and type 1 diabetes, the high rates of DKA in children at diagnosis found in this new research does flag the importance of knowing the symptoms of type 1 diabetes and acting early to reduce the chances of developing serious complications.

Anyone – adult or child – can develop type 1 diabetes and we’d urge you to not let coronavirus fears stop you from seeking medical help if you notice any signs and symptoms.