From 529 million in 2021, diabetes sufferers will exceed 1.3 billion in 2050 (The Lancet Diabetes & Endocrinology). It is confirmed in many studies an increase in diagnoses of up to 40% of new cases of Type 2 Diabetes Mellitus (T2DM), in people who suffered from COVID-19while in many there was no predisposing factor for T2DM.

Causal or chance finding? Possible explanations

A possible association with direct damage of the virus to the cells, or mechanisms of misstimulation, due to the virus, of our immune system, are some hypotheses to explain this increase by the scientific community. But what about insulin-dependent or Juvenile Diabetes type 1?
In a study published in The Lancet Diabetes & Endocrinology, by Mikael Knip, MD, New Children’s Hospital, Helsinki, Finland, and colleagues, both the incidence of type 1 diabetes and the severity of symptoms at onset increased among children and adolescents in Finland in the first 18 months of the COVID-19 pandemic, but it is unclear whether this was due to the SARS-CoV-2 virus itself, as few had confirmed infection before diagnosis. Unfortunately, almost up to a quarter of the study population had not been tested for SARS-CoV-2.

The researchers in their conclusions claim that the results of this study suggest that the increase in the rate of the disease and the frequency of the serious and dangerous complication, namely diabetic ketoacidosis, is related to the preventive measures introduced at the beginning of the pandemic, such as the lockdown and physical distance and much less with the direct impact of SARS-CoV-2.

“However, apart from the causal interpretation, ie that the lockdowns and not the virus may be playing the most important role, a different view is that there is an involvement of the virus, either through inflammation or even a direct destructive effect on beta cells of the pancreas.

This hypothesis is based on previous studies, where the virus has been linked to the development of type 1 diabetes, which have also shown that children may not necessarily test 100% positive for antibodies due to the heterogeneity of the T-cell response and of the inability of the tests to discover him.

So there is a lot of disagreement among the “experts” on the subject in relation to Diabetes and the COVID-19 infection, i.e. to what extent the virus plays a role in the emergence of new cases.
There is definite evidence that even mild infections with SARS-CoV-2 increase the risk of developing Type 2 Diabetes Mellitus. This alone needs close chronic preventive medical monitoring over time,” points out Mr. Antonios Lepouras Specialist Pathologist-DiabetologistDirector of Pathology-Diabetology Clinic and Diabetes Center Metropolitan General.

Type 1 Diabetes Diagnosed More Common During the COVID-19 Pandemic

Knip and colleagues compared data from the Finnish Pediatric Diabetes Registry for the period from March 1, 2020 to August 31, 2021, with those from the same periods for the years 2014-2019. A total of 785 children under the age of 15 were diagnosed during the 18-month pandemic period (3/20-8/21) and a total of 2,096 were diagnosed during the combined 54-month reference period (3/14-8/19).

The incidence of type 1 diabetes was 61 per 100,000 of the under-15 population during the pandemic, significantly higher than the 52.3 per 100,000 observed during the reference period. Comparing the two periods, the age- and sex-adjusted incidence rate ratio was 1.16, which was statistically significant.

Most children had severe complications with diabetic ketoacidosis at diagnosis during the pandemic (30.8% vs. 22.6%) and with a significantly greater frequency at onset of type 1 diabetes (8.8% vs. 5.6%).

Of the 583 children analyzed for SARS-CoV-2 antibodies, (25.7% of study subjects diagnosed with type 1 diabetes), only 5 (1%) were considered to have had acute COVID-19 infection before diagnosis based on two different antibody tests.

The virus can be to blame, but so can the “lockdown at home” (Lockdown)

Preliminary data suggest that the rate of type 1 diabetes has fallen in Finnish children after the lifting of pandemic restrictions in the summer of 2021. There were 211 new cases between September 2021 and February 2022, compared with 301 from March 1, 2020 to August 31, 2021.
The virus may not be to blame for the increase, but confinement

“According to what is known as the biodiversity hypothesis, microbial exposure and infections in early childhood can enhance protection against autoimmune diseases. The reduction in contacts associated with social lockdown significantly reduced acute infections in children, which may have increased the risk of developing type 1 diabetes.

The caveat of course is that the association observed in the study should not be equated as causative, especially without biomarkers or gut microbiota comparisons that could potentially substantiate the biological plausibility of this observation. Also, the very stress of social isolation, together with the death anxiety that was systematically cultivated by the media, constitute in themselves the activation factors of pathological auto-immune mechanisms with the final result of self-destruction of the insulin-secreting β-cells of the pancreas.

The exact mechanisms to explain how social isolation measures affect autoimmunity and biodiversity are very difficult to establish and have yet to be examined.

The message of this study is that the virus may not be solely responsible for the increase in cases of Diabetes Mellitus during the pandemic. At least for type 1, protective confinement, unfortunately, reduced microbial exposure and infections in general, thereby reducing the self-protection mechanisms of our immune system,” concludes Mr. Lepouras.