COVID 19 has clearly left its marks on both individuals and society as a whole, and researchers have found another example of the profound immunological impact of this viral infection in reviewing the medical records of numerous children: COVID increases the rates of type I diabetes in infected children. This should not shock those who understand the risks for such autoimmune diseases, but does add to the growing list of post-COVID issues we face in medicine.
Type I diabetes differs from type 2 in that type 1 arises earlier in life from an autoimmune attack on the insulin producing cells of a child’s pancreas rather than the obesity triggered overwork of the same cells to keep up with metabolic demands. Type 1 can arise in infants through adolescence, and rarely into young adulthood. Immune system destruction of cells called islet cells in the pancreas slowly diminish the number of cells that can produce insulin until the few remaining cells cannot keep up with insulin needs. As this happens, glucose levels begin to rise in the person’s blood until various symptoms bring the issue to medical attention. By the time this happens, it is too late to save the islet cells and prevent life-long disease.
The immune attack seems irrational as our bodies logically should not attack our own cells and tissues. There are however mechanisms by which this occurs which scientists have teased out over years of research. In its most basic form, some trigger initiates an immune response but then cross reacts with our own cell’s chemical structure. The immune system then begins reacting to our own proteins even if the initial trigger disappears.
While our genetics play a major role, some environmental triggers is needed. The trigger can arise from inflammation against a food protein which entered through a leaky gut. It can arise from an immune response to a viral infection that happens to share similarities with one of our cell proteins. This can arise from inflammation in the particular organ being later attacked.
This paper focused on the risk of developing type 1 diabetes after a COVID 19 infection in children under 18 years of age, but did not delve into the mechanisms. One can guess that any one or more of the three mechanisms mentioned above could be the pathway for this autoimmune development. COVID 19 does cause intestinal damage in many and could cause leaky gut. The viral infection could trigger pancreatic inflammation that opens up normally hidden cell proteins for reactivity. Some of the viral proteins which our body attacks in defense could resemble pancreas proteins and thus provide an opportunity for cross reaction, an occurrence called ‘molecular mimicry’.
Given the increase in autoimmunity diseases in general after COVID 19 and the increase in the antibodies associated with these diseases, the molecular mimicry mechanism may be the primary culprit. We would need studies looking at the development of pancreatic islet cell antibodies or GAD antibodies, both of which contribute to the development of type 1 diabetes.
For COVID 19, the study compared children diagnosed with COVID 19 over a particular time period with children diagnosed with other non-COVID respiratory illnesses through an ER. Viral infections had been correlated with increased risks of type I diabetes in past studies. This comparison would tease out whether this was just the effect of viral infections in general or something more specific to COVID 19. The overall rate of type 1 diabetes did increase in the 6 months of follow up after a COVID 19 infection compared to other viral diagnoses found in Emergency Room records. The greater difference was in children 10 through 18 years of age, as in children 0 to 9 years of age the trend was not statistically significant.
The authors urged health care providers and parents of these children to be watching for signs of diabetes after COVID 19 infection if they child is at higher risk of type 1 diabetes. This would include children who have a family history of type 1 diabetes in parents or siblings or extended family. Increased thirst, increased urination, unexplained weight loss, and increased hunger without weight gain could all indicate a need for checking blood sugar in these children.
Recognizing this connection is important for 2 reasons. As diabetes research has continued, we have discovered that residual islet cell function continues for much longer than original thought if sugars can be controlled. Early diagnosis may make this disease more easily managed in the long run. It is also important to consider whether novel preventive therapies being promoted to children might also trigger similar immune reactions. Since we don’t understand the mechanism by which the infection triggers diabetes in children, we should at least monitor children receiving experimental therapies for the development of type 1 diabetes and other autoimmune conditions.
Helping our next generation look forward to healthier more abundant lives without chronic life altering diseases requires thinking about the present and the future implications of monitoring and therapy. Functional medicine tries to think from multiple perspectives across multiple time frames rather than just focus on the immediate gratification of treating an acute disease with a potential lifelong risk.
Ellen K. Kendall, Veronica R. Olaker, David C. Kaelber, Rong Xu, Pamela B. Davis. Association of SARS-CoV-2 Infection With New-Onset Type 1 Diabetes Among Pediatric Patients From 2020 to 2021. JAMA Network Open, 2022; 5 (9): e2233014 DOI: 10.1001/jamanetworkopen.2022.33014
Thanks to Science Daily:
Case Western Reserve University. “COVID-19 associated with increase in new diagnoses of type 1 diabetes in youth, by as much as 72 percent, study finds.” ScienceDaily. ScienceDaily, 23 September 2022. <www.sciencedaily.com/releases/2022/09/220923121735.htm>.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.