The Effect of COVID-19 on Incident Diabetes in Pediatric Patients: Findings From the National COVID-19 Cohort Collaborative (N3C).

Objective: Studies showing increased diabetes incidence in pediatric patients after COVID-19 are from data early in the pandemic, and some studies found conflicting results. Our objective was to evaluate trends in pediatric diabetes incidence and whether COVID-19 was associated with increased risk across viral variant periods. Research Design and Methods: We conducted a retrospective cohort study using National COVID-19 Cohort Collaborative data to evaluate incident diabetes risk among COVID-19-positive pediatric patients compared to COVID-19-negative patients or controls with acute respiratory illness. Cohorts were weighted on demographics, data site, and body mass index percentile. The primary outcome was the cumulative incidence ratio (CIR) of incident diabetes for each viral variant era. Results: There was no difference in the risk of incident diabetes in pediatric patients after COVID-19 compared to patients in COVID-19 negative or ARI control groups during any of the viral variant periods (e.g., ancestral period CIR 1.03, 95% CI 0.65-1.41). The predominant subtype of incident diabetes was T2D. Incidence rates over time followed a U-shaped curve, with the highest incidence in the ancestral variant period. Conclusions: COVID-19 was not associated with an increased risk of diabetes in pediatric patients. Incidence rates were highest early in the pandemic, and mirrored patterns of pandemic-era healthcare utilization. The predominance of incident T2D subtype is concerning for the adverse effects of pandemic-related lifestyle changes among pediatric patients.