The association between Covid-19 and new onset of Type 1 diabetes: a rapid review protocol

Abstract

Background and rationale: this protocol describes a review that is being undertaken to respond to a growing number of reports that there may be a relationship between infection with Covid-19 and a new diagnosis of Type 1 diabetes. We intend to synthesise the literature in order to identify what is currently known and to inform how best research using electronic health records can further explore this relationship to understand the risks and provide appropriate public health guidance.
Type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin, usually due to an auto-immune response which destroys the islets of Langerhans cells in the pancreas ( https://www.diabetes.org.uk/ ). The majority of Type 1 cases occur in childhood or adolescence. There is no cure, and treatment is reliant on replacing insulin using injections or pumps to be able to allow sugar in the bloodstream to enter the cells and control the blood glucose levels. The exact triggers for the development of Type 1 diabetes are unknown, but exposure to viruses and other environmental factors are thought to be important (Filippi and von Herrath, 2008). Seasonal variation in the incidence of new cases has often been attributed to increased viral circulation, for example associated with the return of children to schools (Turtinen et al., 2022, Nishioka et al., 2020). It is unclear whether the SARS-Coronavirus-2 virus (SARS-Cov-2), which is responsible for the Covid-19 pandemic, may influence the development of Type 1 diabetes, although evidence is emerging that there may be an association (Barrett et al., 2022).
The public health approach to controlling SARS-Cov-2/Covid-19 in the UK has varied between regions and also between children and adults. Whereas the focus of the vaccination program has been on reducing hospital admission and death, particularly in older adults and people with clinical vulnerabilities, vaccination for adolescents aged 12-17 were introduced in August/September 2021, and a 2 dose course for children aged 5-11 in 2022. Given the high rates of Covid-19 positivity in educational establishments and the lack of other precautionary measures, such as mandatory use of face coverings, adequate ventilation and air filtration, the scope for transmission to children and subsequent sequelae, such as Long Covid, remains significant (Zimmermann et al., 2022). Additionally, the increased difficulty in accessing both primary and secondary care health services during periods of lockdown and in the post-lockdown era may have contributed to delays in diagnosis and increased severity of presentation, and this may also be reflected in the global literature.
As the pandemic continues with successive waves of new variants of the virus, with as-yet unknown effects on the immune system and long-term health, we would like to focus on the potential role of Covid-19 in the development of new-onset Type 1 diabetes as a matter of urgency, to be able to inform public health and parental decisions about vaccination and safety measures in schools, and also to inform subsequent research using large routinely collected data sources, such as the SAIL databank and the Brecon paediatric diabetes cohort. For this purpose, a rapid review is the most suitable methodology due to its resource-efficient methods of producing a quality knowledge synthesis that can guide stakeholders to future public health and/or research funding decisions.

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ORCID for Carole Fogg: orcid.org/0000-0002-3000-6185

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