P-04: Incidence of pediatric type 1 diabetes beyond the COVID-19 pandemic
A J Eckert, C Kamrath, E Seidel-Jacobs, B Karges, O Kordonouri, K Warncke, D Klose, T Kapellen, B Heidtmann, H Schöttler, C Denzer, J Rosenbauer, S LanzingerAbstract
Introduction
In Germany, as in many countries, the incidence of pediatric type 1 diabetes (T1D) increased during the first years after the COVID-19 emergence (2020-2022), especially in young children.
Objectives
To follow the course of pediatric T1D incidence in Germany beyond the acute COVID-19 pandemic.
Methods
Data of children and adolescents aged 0.5-17 years from the German multicenter Diabetes Prospective Follow-up (DPV-) registry, capturing >90% of pediatric cases with diabetes, with clinical onset of T1D between 2011 and 2025 were analyzed. Incidence rate ratios (IRRs) for the single years 2020-2025 and for the whole period were estimated based on the pre-pandemic trend from 2011-2019.
Results
43,649 children and adolescents were included (55.1% male, 25.3% with migration background). Median age at diagnosis was 9.8 years pre- and post-pandemic, but 9.3 years during the acute pandemic (2020-2022). T1D incidence increased from 17.6 [95%-CI: 16.9-18.3] in 2011 to 22.1 [21.3-22.8] cases / 100,000 person-years in 2019 (relative annual increase: 2.1% [0.8-3.4]). Based on this trend, the observed incidence was significantly higher than expected in 2020 (IRR: 1.15 [1.09-1.21]), 2021 (1.23 [1.17-1.29]) and 2022 (1.15 [1.09-1.20]), but significantly lower than expected in 2023 (0.93 [0.89-0.98]), 2024 (0.84 [0.80-0.89]) and 2025 (0.85 [0.81-0.90]). The IRR for 2020-2025 combined was 1.02 [1.00-1.04], p=0.058. The age-stratified IRRs for 2020-2025 combined were 1.22 [1.17-1.27] in children aged <6 years, 1.01 [0.98-1.04] in children aged 6-<12 years and 0.90 [0.87-0.93] in adolescents aged 12-<18 years.
Conclusions
These preliminary data suggest that there is no substantial persistent increase in T1D incidence beyond the expected level when combining all years since the COVID-19 pandemic. Together with the temporary decrease in onset age and the different IRRs by age group this suggests a wave-like T1D incidence pattern that might have (nearly) normalized as of 2025.