Reports about the relation of SARS-CoV-2 infection and diabetes in children have showed consistent results. Davoodi et al. [2] reported a significantly higher rate of new T1D in children during the pandemic, as well as increased number of cases of diabetic ketoacidosis (DKA). Studies also have shown higher severity of DKA and the need for higher doses of insulin in such patients [2]. These changes likely were caused by increased damage to the pancreatic beta cells by SARS-CoV-2 infection. However, they did not investigate COVID-19 status of the patients prior to progression into T1D.

Ho et al. [3] also reported significant increases in DKA and severe DKA in children presenting with new-onset T1D during the COVID-19 pandemic.

Rahmati et al. [4] performed a systematic review and meta-analysis of the risk of pediatric T1D and DKA before and after the pandemic. Compared with the pre-COVID-19 era, the number of worldwide new-onset pediatric T1D, DKA, and severe DKA cases during the first year of the COVID-19 pandemic increased by 9.5%, 25%, and 19.5%, respectively. Compared with pre-COVID-19 pandemic levels, the median glucose and HbA1c values in newly diagnosed T1D children after the COVID-19 pandemic increased by 6.43% and 6.42%, respectively. The COVID-19 pandemic significantly increased the risk of global pediatric new-onset T1D, DKA, and severe DKA. Related public mandates targeted measures to raise public and physician awareness of these relationships [4]. Gullu et al. [5] evaluated the presentation patterns, severity, autoantibody status, and seasonal variability of newly diagnosed T1D patients during two years of the pandemic compared to those in the pre-pandemic period. Number of patients presenting with DKA was significantly higher during the pandemic period, and the number of patients presenting with severe DKA was significantly higher during the pandemic period. Islet-cell antibody (ICA) positivity was significantly higher in patients admitted during the pandemic, especially in its second year. Anti-glutamic-acid-decarboxylase-antibody-ICA copositivity was significantly higher in patients admitted during the pandemic period, especially those admitted in the second year of the pandemic [5]. This study by Stout et al. [6] reported increased incidence of new-onset diabetes among children in Mississippi and assessed the relationships of changes in inflammatory biomarkers including psychosocial risk factors and new-onset diabetes during the pandemic. Surprisingly, they reported that 33% of new-onset T1D cases had positive SARS-CoV-2 IgG antibody (Ab), and 62% of those with T2D had positive IgG Ab. More than half (54%) of their new-onset diabetes patients were experiencing DKA [6]. Their T2D patients showed higher body mass index (BMI), lower vitamin D levels, and higher leptin and C-reactive protein levels compared to those of T1D patients. There was no significant difference in psychosocial factors, interleukin-6 level, or SARS-CoV-2 Ab status in T1D and T2D patients [6]. In addition, they were unable to demonstrate significant correlations between COVID-19 infectious biomarkers and new-onset diabetes, although they did show a correlation between increased BMI and T2D in Mississippi during the pandemic. Lee et al. [7] retrospectively reviewed 73 children with T1D and 50 children with T2D diagnosed with SARS-CoV-2 infection. They reported that all children with diabetes and COVID-19 had mild clinical features due to low disease severity, high vaccination rates, uninterrupted access to medical care, and continuous glucose monitoring.