187 - Association between SARS-CoV-2 infection and new onset diabetes mellitus in children

In a prospective study, children admitted to Children’s of Alabama between 8/4/2021 and 10/18/2022 with a new diagnosis of T1D or T2D and those patients with a known diagnosis of T1D or T2D presenting with DKA or other complications were enrolled. Remnant blood samples collected from clinical blood draws were analyzed for SARS-CoV-2 specific antibodies using a multiplex assay for immunoglobulin G (IgG) against the spike and nucleocapsid antigens of SARS-CoV-2. Clinical and laboratory data were abstracted from the electronic medical record. Medians, IQR were calculated for continuous variables and percentages for categorical variables. Pearson Chi squared or Fischer exact test were used for measures of association. Statistical analyses were conducted using SPSS version 28 (IBM®).

Results: The demographic and clinical characteristics are shown in table 1. Most children (81.5%) with new onset T2D were SARS-CoV2 IgG positive compared to 45.9% of children with new onset T1D. 23 children were spike IgG positive but nucleocapsid IgG negative, most likely due to receipt of COVID-19 vaccine. Table 2 compares children with new onset T1D and T2D. The presence of nucleocapsid IgG (suggestive of past or current infection) was associated with new onset T2D (p = 0.008) and not new onset T1D (p = 0.35). Only 7 children had a positive nasopharyngeal (NP) swab PCR at presentation (6 presenting in DKA), of which only 1 had concomitant viremia. We observed a racial difference with nucleocapsid IgG status with presence in 34.8% white non-Hispanic, 50% African-American, and 75% Hispanic children.

Conclusion(s): Although our numbers are small, we found a higher proportion of children with new onset T2D had nucleocapsid IgG than new onset T1D, suggesting an association between SARS-CoV-2 infection (past or current) and new onset T2D. We also found a racial / ethnic disparity, suggesting race as a confounder warranting further investigation.