Dietler Dominik, Björk Jonas, Palmkvist Elsa, Carlsson Annelie
Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden.
Diabetologia. 2025 Sep 18. doi: 10.1007/s00125-025-06540-1.
AIMS/HYPOTHESIS: The incidence of type 1 diabetes increased during the pandemic in various countries. SARS-CoV-2 infections may trigger the development of type 1 diabetes, but the evidence is inconclusive. This study aimed to assess trends in type 1 diabetes incidence between 2007 and 2023, and to quantify the association between SARS-CoV-2 infections and the risk for developing type 1 diabetes.
The study included all individuals under 30 years old registered in Sweden. Deviations in type 1 diabetes incidence from pre-pandemic trends (2007-2019) were assessed for each pandemic year (2020-2023) using Poisson regression. The effect of SARS-CoV-2 infections was assessed using Cox proportional hazards models in a cohort of infected individuals with five control individuals from the infection date of the case, matched by birth year, sex and region.
Compared with the predicted linear trend, type 1 diabetes incidence increased by 12% during 2021 (incidence rate ratio [IRR] 1.12; 95% CI 1.06, 1.19) and 9% during 2022 (IRR 1.09; 95% CI 1.02, 1.16), but reverted to pre-pandemic trends in 2023. Overall, the adjusted HR for developing type 1 diabetes after SARS-CoV-2 infection was 0.96 (95% CI 0.79, 1.16). Children between 5 and 10 years old were more likely to develop type 1 diabetes within the first 28 days after infection (HR 2.68; 95% CI 1.22, 5.89), although their hazard over the whole follow-up period was not increased.
CONCLUSIONS/INTERPRETATION: Sweden, with its non-restrictive pandemic response, saw a transient increase in type 1 diabetes incidence that was only partially associated with SARS-CoV-2 infections. Other explanations should be investigated, including environmental and lifestyle factors.
目的/假设：在疫情期间，各国1型糖尿病的发病率有所上升。新型冠状病毒2感染可能会引发1型糖尿病的发展，但证据并不确凿。本研究旨在评估2007年至2023年期间1型糖尿病发病率的趋势，并量化新型冠状病毒2感染与患1型糖尿病风险之间的关联。
该研究纳入了瑞典所有登记在册的30岁以下个体。使用泊松回归评估每个疫情年份（2020 - 2023年）1型糖尿病发病率与疫情前趋势（2007 - 2019年）的偏差。在一组感染个体中，使用Cox比例风险模型评估新型冠状病毒2感染的影响，每例感染个体匹配五名对照个体，匹配因素包括出生年份、性别和地区。
与预测的线性趋势相比，2021年1型糖尿病发病率增加了12%（发病率比[IRR] 1.12；95%置信区间1.06，1.19），2022年增加了9%（IRR 1.09；95%置信区间1.02，1.16），但在2023年又恢复到疫情前的趋势。总体而言，新型冠状病毒2感染后患1型糖尿病的调整后风险比为0.96（95%置信区间0.79，1.16）。5至10岁的儿童在感染后的前28天内患1型糖尿病的可能性更大（风险比2.68；95%置信区间1.22，5.89），尽管他们在整个随访期内的风险并未增加。
结论/解读：瑞典在疫情应对措施较为宽松的情况下，1型糖尿病发病率出现了短暂上升，且仅部分与新型冠状病毒2感染有关。应研究其他解释，包括环境和生活方式因素。
