Publication Name	World Journal of Diabetes
Manuscript ID	112939
Country	China

Category	Endocrinology & Metabolism
Manuscript Type	Letter to the Editor
Article Title	Reevaluating the relationship between COVID-19 and type 1 diabetes mellitus: Methodological considerations
Manuscript Source	Invited Manuscript
All Author List	Er-Min Liang and Hong-Cheng Luo
Funding Agency and Grant Number
Corresponding Author	Hong-Cheng Luo, MD, Department of Urology, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennan Zhong Road, Futian District, Shenzhen 518033, Guangdong Province, China. drlhc96@163.com
Key Words	Type 1 diabetes mellitus; Coronavirus disease 2019; Incidence; Seasonality; Epidemiology; Viral infections; Bias
Core Tip	Carmon et al’s study suggests a link between the coronavirus disease 2019 pandemic and rising type 1 diabetes mellitus cases. This letter provides a constructive critique of their methodology. The authors point out that ecological analysis without individual infection data can be misleading, unaddressed confounders and lack of coronavirus disease 2019 (COVID-19) stratification weaken causal inference, and pandemic-related diagnostic delays (reflected in higher diabetic ketoacidosis rates) may have inflated case counts. The authors also caution that biases in viral surveillance data complicate the interpretation of “reduced” non-COVID infections. Addressing these issues with more granular data and analyses will improve future research on the type 1 diabetes mellitus-COVID relationship.
Citation	Liang EM, Luo HC. Reevaluating the relationship between COVID-19 and type 1 diabetes mellitus: Methodological considerations. World J Diabetes 2025; In press

Received	2025-08-11 05:49
Peer-Review Started	2025-08-11 09:49
To Make the First Decision
Return for Revision	2025-08-20 07:13
Revised	2025-08-25 17:22
Second Decision	2025-10-20 02:45
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2025-10-20 09:34
Articles in Press	2025-10-20 09:34
Publication Fee Transferred
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-9358 (online)
Open Access	This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Copyright	© The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Permissions	For details, please visit: http://www.wjgnet.com/bpg/gerinfo/207
Publisher	Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Website	http://www.wjgnet.com