Association between enterovirus infection and clinical type 1 diabetes mellitus: systematic review and meta-analysis of observational studies

• Published in: Epidemiology and infection Vol. 150; p. e23
• Main Authors: Yang, Sen, Zhao, BiYing, Zhang, Zhen, Dai, XiaoLin, Zhang, YiLi, Cui, LanWei
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 10-12-2021
• Subjects: Adolescent; Adult; Age; Age composition; Aged; Animal models; Antibodies; Biopsy; Child; Child, Preschool; Confidence intervals; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Enterovirus Infections - complications; Enterovirus Infections - epidemiology; Enteroviruses; Epidemiology; Heterogeneity; Humans; Immunology; Infant; Infant, Newborn; Infections; Meta-analysis; Middle Aged; Observational studies; Observational Studies as Topic; Original Paper; Proteins; Quality of life; Sensitivity analysis; Socioeconomic factors; Statistical analysis; Subgroups; Systematic review; Viral infections; Viruses; Young Adult; Sweden; enterovirus infection; meta-analysis; Clinical T1DM; observational studies
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268821002442

Numerous animal models and epidemiological and observational studies have demonstrated that enterovirus (EV) infection could be involved in the development of clinical type 1 diabetes mellitus (T1DM), but its aetiology is not fully understood. Therefore, we reviewed the association between EV infection and clinical T1DM. We searched PubMed and Embase from inception to April 2021 and reference lists of included studies without any language restrictions in only human studies. The correlation between EV infection and clinical T1DM was calculated as the pooled odds ratio (OR) and 95% confidence intervals (CIs), analysed using random-effects models. Subgroup and sensitivity analyses were performed to evaluate the robustness of the associations. A total of 25 articles (22 case–control studies and three nested case–control studies) met the inclusion criterion including 4854 participants (2948 cases and 1906 controls) with a high level of statistical heterogeneity (I2 = 80%, P < 0.001) mainly attributable to methods of EV detection, study type, age distribution, source of EV sample and control subjects. Meta-analysis showed a significant association between EV infection and clinical T1DM (OR 5.75, 95% CI 3.61–9.61). There is a clinically significant association between clinical T1DM and EV infection.