Autoimmunity in children with type 1 diabetes in association with the COVID_19 pandemic - results from the prospective DPV Registry

Claudia Boettcher; Holl Reinhard W; Katrin Nagl; Beate Karges; Simone Sengbusch; Alena Welters; Katharina Warncke; Monika Flury; Diyah Nahdiyati; dem Berge Thekla von; Clemens Kamrath

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ESPE Abstracts (2024) 98 RFC15.4

ESPE2024 Rapid Free Communications Late Breaking (6 abstracts)

Autoimmunity in children with type 1 diabetes in association with the COVID_19 pandemic - results from the prospective DPV Registry

Claudia Boettcher ¹ , Reinhard W Holl ^2,3 , Katrin Nagl ⁴ , Beate Karges ⁵ , Simone Sengbusch ⁶ , Alena Welters ⁷ , Katharina Warncke ^8,9 , Monika Flury ¹⁰ , Diyah Nahdiyati ¹¹ , Thekla von dem Berge ¹² & Clemens Kamrath ¹³

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¹University Children's Hospital, Julie-von-Jenner Haus, University of Bern, Paediatric Endocrinology and Diabetology, Bern, Switzerland. ²University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany. ³German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany. ⁴Medical University Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria. ⁵Medical Faculty, RWTH Aachen University, Division of Endocrinology and Diabetes, Aachen, Germany. ⁶Division of Peadiatric Endocrinology and Diabetology, University Medical Center Schleswig- Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany. ⁷Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. ⁸Kinderklinik München Schwabing, School of Medicine, Technical University Munich, Department of Pediatrics, Munich, Germany. ⁹Helmholtz Munich, German Center for Environmental Health, Institute of Diabetes Research, Munich, Germany. ¹⁰Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Department of Paediatrics, Division of Paediatric Endocrinology and Diabetes, Dresden, Germany. ¹¹Rehabilitation Centre for Children and Youth, Viktoriastift Clinic, Bad Kreuznach, Germany. ¹²Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany. ¹³Centre for Paediatric and Adolescent Medicine, University of Freiburg, Section of Paediatric Endocrinology and Diabetology, Freiburg i. Br., Germany

Background and aim: Type 1 diabetes mellitus (T1D) is associated with other autoimmune diseases, often with a sex preference. The onset of the COVID-19 pandemic has led to reports on an increasing risk of autoimmune diseases. Our research aimed to investigate (concomitant) autoimmunity in children with T1D manifestation during the COVID-19 pandemic, considering gender and age, compared to pre-pandemic onset.

Methods: We analysed data of 21,654 children and adolescents aged 0.5-18 years without migration background from the DPV data pool with a T1D manifestation from 2015 to 2023. Rates of beta cell antibodies (ab) [IA2-, ZnT8-, GAD-, insulin-ab (max. four weeks after manifestation)], thyroid-, transglutaminase (TGA)-, and adrenal -ab were determined. Logistic regression models with age and gender as confounders served to investigate the influence of manifestation before (2015-19) versus during (2020-2023) the COVID-19 pandemic on endocrine autoimmunity.

Results: The included children and adolescents had a mean age of 9.6 years and a mean T1D duration of 0.34 years. 11,733 individuals had a T1D diagnosis before and 9,921 after the emergence of COVID-19. The table shows more population characteristics. T1D-onset after the beginning of the COVID-19 pandemic was associated with a higher rate of beta-cell autoimmunity, especially in IA2 (P <0.001 each), whilst there was a negative effect of the pandemic on ZnT8-ab (P <0.001), mainly in girls (P <0.0001). For GAD- and insulin-ab, no effects of the pandemic were seen. T1D-onset after the pandemic's beginning was negatively associated with adrenal-ab (P <0.0001). Neither thyroid- nor TGA-ab-positivity was associated with the COVID-19 pandemic.


	Females		Males	Age
	Females		Males	<6		6 - ≤ 12		12 - ≤ 18
	N	Mean	N	Mean	N	Mean	N	Mean	N	Mean
Age (y)	9,688	9.24	11,966	9.90	5,237	3.73	9,100	9.16	7,317	14.36
T1D duration (y)	9,688	0.34	11,966	0.33	5,237	0.32	9,100	0,34	7,317	0.34
BMI-SDS (KIGGS)	9,629	0.13	11,907	0.12	5,231	0.38	9,054	0.10	7,269	-0.03
Beta-cell + (%)	6,434	91.92	8,006	91.41	3,556	91.09	6,059	91.58	4,825	92.10
Thyroid-ab + (%)	6,815	10.79	8,474	5.05	3,664	3.08	6,469	7.45	5,156	10.99
TGA-ab + (%)	6,189	9.94	7,610	7.45	3,312	10.53	5,820	9.26	4,667	6.63
Adrenal-ab + (%)	680	5.88	760	4.47	361	6.37	637	4.55	442	4.98

Conclusion: The influence of the COVID-19 pandemic on beta-cell autoimmunity in children with new-onset T1D remains unclear. The COVID-19 pandemic does not seem to trigger the development of additional endocrine autoimmunity in children and adolescents with T1D.