Increase in Incidence of Type 1 Diabetes in Children and Adolescents

Between January 2020 and June 2021, more children and adolescents in Germany were newly diagnosed with type 1 diabetes than in comparable earlier periods. This was the result of a nationwide study using data from the multicenter Diabetes Prospective Follow-up Registry (DPV*). However, the research team led by DZD Professor Reinhard W. Holl could not prove a direct link between this rising incidence and the coinciding COVID-19 pandemic and concluded that indirect rather than direct effects of the pandemic were more likely to be the cause.

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The study by the DZD, the University of Giessen, and the University of Ulm, with co-authors from other centers in Germany, aimed to investigate the incidence of type 1 diabetes in children and adolescents during the COVID-19 pandemic in Germany compared with previous years.

"The incidences of type 1 diabetes increased with a delay of about three months after the COVID-19 incidence waves and after the measures to contain the pandemic," said last author Holl from the University of Ulm. However, the underlying causes for the increase in type 1 diabetes incidence are still unknown, the researchers emphasized. The DPV data do not indicate whether the children and adolescents recorded in the registry had actually been infected with the Sars Cov-2 virus.

A study by the U.S. Center for Disease Control (CDC), which was based on data from two databases with, however, different results, suggested a possible link. This was criticized in expert circles because the study had serious methodological flaws. Among other things, it did not distinguish between the occurrence of type 1 and type 2 diabetes, which is diagnosed more frequently in this age group in the USA than in Europe.

The German research team suspects the increased numbers to be an indirect consequence of the pandemic rather than a direct trigger by a COVID-19 infection. This is because the pandemic containment measures left the immune system less trained, while the children and adolescents were exposed to more stress.

During the study period, 5,162 children and adolescents with new-onset type 1 diabetes were registered in the DPV. This corresponds to an incidence of 24.4 per 100,000 persons. What would have been expected was 21.2 – determined using Poisson regression models from data from 2011 to 2019 for 2020/21. Thus, the observed incidence during the COVID-19 pandemic was significantly higher than expected. New cases increased particularly in July 2020, March 2021, and June 2021.

Detailed information

* Diabetes Prospective Follow-up Registry (DPV):
Currently, more than 400 treatment facilities participate in the Diabetes Prospective Follow-up Registry – mainly from Germany and Austria, but also from Luxembourg and Switzerland. Data from more than 680,000 patients are recorded in the DPV. The goal of the DPV initiative is to improve treatment outcomes for people with diabetes in routine care through standardized documentation, objective comparison of quality indicators, and multicenter therapy research. 

Original publication:
Kamrath, C. …. Holl, R. et al.: Incidence of Type 1 Diabetes in Children and Adolescents During the COVID-19 Pandemic in Germany: Results From the DPV Registry. Diabetes Care (2022) DOI: