Lee Da Hye, Kim Hwa Young, Park Ji Young, Kim Jaehyun, Park Jae Hyeon
Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea.
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
JAMA Pediatr. 2025 Feb 1;179(2):155-162. doi: 10.1001/jamapediatrics.2024.5068.
Whether COVID-19 contributes to youth-onset diabetes is controversial, and research in Asia is lacking.
To explore the incidence and severity of diabetes among youths during the COVID-19 pandemic in South Korea.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used claims data for January 1, 2017, through February 28, 2022, from the National Health Insurance Service database in South Korea. The incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in patients younger than 20 years during the pandemic was analyzed and compared with that during the prepandemic period. The study included incident cases of T1D identified by at least 2 diagnosis codes with at least 2 insulin prescriptions within 1 year and T2D identified by at least 2 diagnosis codes with at least 2 prescriptions of diabetes medication within 1 year. Analyses were performed between January 29 and September 2, 2024.
COVID-19 pandemic and SARS-CoV-2 infection.
The primary outcome was incidence of T1D and T2D, and secondary outcomes included the rate of diabetic ketoacidosis (DKA) and association of new-onset diabetes with SARS-CoV-2 positivity.
The study included 2599 patients with T1D (mean [SD] age, 12.0 [4.8] years; 1235 [47.5%] male) and 11 040 patients with T2D (mean [SD] age, 16.0 [2.8] years; 6861 [62.1%] male). During the pandemic, the incidence rate ratios were 1.19 (95% CI, 1.10-1.29) for T1D and 1.41 (95% CI, 1.36-1.46) for T2D. The incidence rate of DKA at diagnosis increased during the first pandemic year compared with the prepandemic period (T1D, 42.8% [95% CI, 38.5%-47.0%] vs 31.3% [95% CI, 29.0%-33.7%], respectively; T2D, 6.0% [95% CI, 5.0%-7.1%] vs 2.9% [95% CI, 2.5%-3.3%], respectively) but returned to prepandemic levels in the second pandemic year (T1D, 34.5% [95% CI, 30.6%-38.5%]; T2D, 3.2% [95% CI, 2.6%-3.9%]). The hazard ratio for new-onset diabetes associated with SARS-CoV-2 positivity was 0.44 (95% CI, 0.17-1.13) for T1D and 1.08 (95% CI, 0.74-1.57) for T2D.
These findings suggest that the incidence and severity of T1D and T2D among South Korean youths increased during the COVID-19 pandemic. The cohort analysis does not support SARS-CoV-2 infection itself as being directly associated with incident diabetes.
2019冠状病毒病（COVID-19）是否会导致青少年糖尿病存在争议，且亚洲地区缺乏相关研究。
探讨韩国在COVID-19大流行期间青少年糖尿病的发病率和严重程度。
设计、背景和参与者：这项队列研究使用了韩国国民健康保险服务数据库中2017年1月1日至2022年2月28日的理赔数据。分析了大流行期间20岁以下患者1型糖尿病（T1D）和2型糖尿病（T2D）的发病率，并与大流行前时期进行比较。该研究纳入了在1年内由至少2个诊断代码和至少2次胰岛素处方确诊的T1D病例，以及在1年内由至少2个诊断代码和至少2次糖尿病药物处方确诊的T2D病例。分析于2024年1月29日至9月2日进行。
COVID-19大流行和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染。
主要结局是T1D和T2D的发病率，次要结局包括糖尿病酮症酸中毒（DKA）发生率以及新发糖尿病与SARS-CoV-2阳性的关联。
该研究纳入了2599例T1D患者（平均[标准差]年龄，12.0[4.8]岁；1235例[47.5%]为男性）和11040例T2D患者（平均[标准差]年龄，16.0[2.8]岁；6861例[62.1%]为男性）。在大流行期间T1D的发病率比为1.19（95%置信区间[CI]，1.10 - 1.29），T2D的发病率比为1.41（95%CI，1.36 - 1.46）。与大流行前时期相比，在大流行的第一年，确诊时DKA的发病率有所增加（T1D分别为42.8%[95%CI，38.5% - 47.0%]对31.3%[95%CI，29.0% - 33.7%]；T2D分别为6.0%[95%CI，5.0% - 7.1%]对2.9%[95%CI，2.5% - 3.3%]），但在大流行的第二年又恢复到大流行前水平（T1D为34.5%[95%CI，30.6% - 38.5%]；T2D为3.2%[95%CI，2.6% - 3.9%]）。与SARS-CoV-2阳性相关的新发糖尿病的风险比，T1D为0.44（95%CI，0.17 - 1.13），T2D为1.08（%CI，0.74 - 1.57）。
这些发现表明，在COVID-19大流行期间，韩国青少年中T1D和T2D的发病率和严重程度有所增加。队列分析不支持SARS-CoV-2感染本身与新发糖尿病直接相关。
